Michael Rutter

381 timestamped statements across 5 collections — auto-found in recorded discussions, each timestamp jumps to the exact moment.

Aerodigestive / ENT · guest expert

Featured diaries

▶ Ep 12 · 1:34
You had a stenosis, you put through a small dilator, cat tail dilator, a bougie, a endotracheal tube, and then you put a slightly bigger one through, and then a bigger one through, and you slowly stretch up the stenosis. A lot of shear forces, quite a lot of mucosal damage. And so this wasn't enormously successful, but it was the best that we had for a long time.
quote · Aerodigestive / ENT
▶ Ep 19 · 2:18
And so this is a slight tracheoplasty technique, and you can see the bougie in the esophagus, we've transected the trachea above and below, and we're sewing this flap of trachea onto the esophagus, so the front wall of the esophagus is now gonna be a piece of trachea, just a a quick running suture technique with 4 OPDS.
quote · Aerodigestive / ENT
▶ Ep 10 · 2:18
And so this is a slight tracheoplasty technique, and you can see the bougie in the esophagus, we've transected the trachea above and below, and we're sewing this flap of trachea onto the esophagus, so the front wall of the esophagus is now gonna be a piece of trachea, just a a quick running suture technique with 4 OPDS.
quote · Tracheoesophageal Fistula
▶ Ep 10 · 4:23
She's had two thoracotomies, you couldn't mobilize her esophagus, and so we stabilized her initially by putting in an esophageal stent, bought her some time, that didn't fix the holes, but got rid of the mediastinal communication.
quote · Tracheoesophageal Fistula
▶ Ep 2 · 1:41:43
You should always go in with an index of suspicion in any child who's had a TEF repair and is still aspirating. Is there a laryngeal cleft?
quote · CHARGE Syndrome
▶ Ep 2 · 1:44:26
You have to accept with this that you have a failure rate, and you have to be prepared to come back and do it again.
quote · CHARGE Syndrome

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Aerodigestive / ENT 190 entries

Aerodigestive & Esophageal Surgery - Difficult Tracheal Esophageal Fistula

▶ Ep 2 · 4:39
clinical Most children who aspirate have a functional or neurological problem (cerebral palsy, CHARGE syndrome); some have anatomical problems (TEF, laryngeal cleft, pharyngeal scar, esophageal stenosis). ↗
▶ Ep 2 · 4:39
clinical Most children who aspirate have a functional or neurological problem (cerebral palsy, CHARGE syndrome); some have anatomical problems (TEF, laryngeal cleft, pharyngeal scar, esophageal stenosis). ↗
▶ Ep 2 · 12:10
clinical A 3-French bugbee cautery is a smooth, excellent probe for identifying subtle tracheoesophageal fistulas. ↗
▶ Ep 2 · 12:10
clinical A 3-French bugbee cautery is a smooth, excellent probe for identifying subtle tracheoesophageal fistulas. ↗
▶ Ep 2 · 13:21
clinical A 70-degree endoscope is a difficult tool to use but can visualize TEFs that are otherwise hard to see with standard forward-viewing scopes. ↗
▶ Ep 2 · 13:21
clinical A 70-degree endoscope is a difficult tool to use but can visualize TEFs that are otherwise hard to see with standard forward-viewing scopes. ↗
▶ Ep 2 · 14:51
clinical Pediatric surgery fellows at Cincinnati Children's complete a one-month attachment with ENT to perform bronchoscopies and gain airway expertise. ↗
▶ Ep 2 · 14:51
clinical Pediatric surgery fellows at Cincinnati Children's complete a one-month attachment with ENT to perform bronchoscopies and gain airway expertise. ↗
▶ Ep 2 · 23:41
clinical Endoscopic TEF closure requires demucosalization of the tract (mucosa is a non-stick surface); the goal is raw-against-raw apposition with minimal fibrin glue (0.1 mL) to seal the tract while scarring occurs. ↗
▶ Ep 2 · 23:41
clinical Endoscopic TEF closure requires demucosalization of the tract (mucosa is a non-stick surface); the goal is raw-against-raw apposition with minimal fibrin glue (0.1 mL) to seal the tract while scarring occurs. ↗
▶ Ep 2 · 30:20
quote You don't want to give the mucosa a fright, you want to destroy it. ↗
▶ Ep 2 · 30:20
quote You don't want to give the mucosa a fright, you want to destroy it. ↗
▶ Ep 2 · 34:20
clinical Positive-pressure air insufflation (30 cm H₂O) via an endotracheal tube in the esophagus can reveal a TEF by causing air to bubble out of the tracheal opening. ↗
▶ Ep 2 · 34:20
clinical Positive-pressure air insufflation (30 cm H₂O) via an endotracheal tube in the esophagus can reveal a TEF by causing air to bubble out of the tracheal opening. ↗
▶ Ep 2 · 37:01
clinical Endoscopic TEF repair success rate is approximately 80%, typically requiring 2 attempts; after 3–4 failed attempts, open repair should be considered. ↗
▶ Ep 2 · 37:01
clinical Endoscopic TEF repair success rate is approximately 80%, typically requiring 2 attempts; after 3–4 failed attempts, open repair should be considered. ↗
▶ Ep 2 · 38:35
clinical When cauterizing in the airway with a bugbee, oxygen concentration should be kept below 30% to minimize fire risk; brief periods of lower oxygen saturation are tolerable. ↗
▶ Ep 2 · 38:35
clinical When cauterizing in the airway with a bugbee, oxygen concentration should be kept below 30% to minimize fire risk; brief periods of lower oxygen saturation are tolerable. ↗
▶ Ep 2 · 39:48
clinical Injection of an inert material (e.g., Radiesse voice gel) into the walls adjacent to a TEF tract can obliterate the potential space and promote raw-on-raw apposition; the material is absorbed over a few weeks. ↗
▶ Ep 2 · 39:48
clinical Injection of an inert material (e.g., Radiesse voice gel) into the walls adjacent to a TEF tract can obliterate the potential space and promote raw-on-raw apposition; the material is absorbed over a few weeks. ↗
▶ Ep 2 · 45:48
clinical Slide tracheoplasty for TEF involves transecting the trachea above and below the fistula, beveling the edges, turning in the tracheal wings to repair the esophagus, interposing sternal periosteum, and reconnecting the trachea; it is a three-layer repair. ↗
▶ Ep 2 · 45:48
clinical Slide tracheoplasty for TEF involves transecting the trachea above and below the fistula, beveling the edges, turning in the tracheal wings to repair the esophagus, interposing sternal periosteum, and reconnecting the trachea; it is a three-layer repair. ↗
▶ Ep 2 · 46:52
clinical Sternal periosteum is an excellent interposition graft material: it is abundant, in the surgical field, and extremely strong ('like Kevlar'), though difficult to suture. ↗
▶ Ep 2 · 46:52
clinical Sternal periosteum is an excellent interposition graft material: it is abundant, in the surgical field, and extremely strong ('like Kevlar'), though difficult to suture. ↗
▶ Ep 2 · 53:37
guideline Button batteries can cause ongoing tissue injury for weeks after ingestion, even if 'dead' (they retain ~2 volts); institutional protocol mandates removal within 2 hours of identification. ↗
▶ Ep 2 · 53:37
guideline Button batteries can cause ongoing tissue injury for weeks after ingestion, even if 'dead' (they retain ~2 volts); institutional protocol mandates removal within 2 hours of identification. ↗
▶ Ep 2 · 54:02
clinical Two slide tracheoplasty repairs for button battery TEF both dehisced (one at 10 days, one at 3 months); both were successfully revised. This may be more than coincidence, suggesting button battery injuries pose unique challenges. ↗
▶ Ep 2 · 54:02
clinical Two slide tracheoplasty repairs for button battery TEF both dehisced (one at 10 days, one at 3 months); both were successfully revised. This may be more than coincidence, suggesting button battery injuries pose unique challenges. ↗
▶ Ep 2 · 1:04:43
clinical Transtracheal repair technique: anterior tracheotomy, identify the fistula from within the trachea, separate tracheal and esophageal layers, three-layer closure (esophageal mucosa with knots in lumen, sternal periosteum, tracheal wall with knots in lumen). ↗
▶ Ep 2 · 1:04:43
clinical Transtracheal repair technique: anterior tracheotomy, identify the fistula from within the trachea, separate tracheal and esophageal layers, three-layer closure (esophageal mucosa with knots in lumen, sternal periosteum, tracheal wall with knots in lumen). ↗
▶ Ep 2 · 1:09:04
opinion Transtracheal TEF repair is a two-dimensional operation with lower complication risk than slide tracheoplasty; the primary complication is re-fistulization, whereas slide tracheoplasty dehiscence is a more serious event. ↗
▶ Ep 2 · 1:09:04
opinion Transtracheal TEF repair is a two-dimensional operation with lower complication risk than slide tracheoplasty; the primary complication is re-fistulization, whereas slide tracheoplasty dehiscence is a more serious event. ↗
▶ Ep 2 · 1:09:59
opinion Slide tracheoplasty appears to be a learning-curve, surgeon-dependent operation; revision cases have been necessary as experience was gained. ↗
▶ Ep 2 · 1:09:59
opinion Slide tracheoplasty appears to be a learning-curve, surgeon-dependent operation; revision cases have been necessary as experience was gained. ↗
▶ Ep 2 · 1:17:21
clinical When repairing a high TEF from a thoracic approach, ligation of the fistula on the esophageal side can leave a large tracheal pouch; if the patient has tracheomalacia and requires a tracheostomy, the tube may enter the pouch, causing life-threatening obstruction. ↗
▶ Ep 2 · 1:17:21
clinical When repairing a high TEF from a thoracic approach, ligation of the fistula on the esophageal side can leave a large tracheal pouch; if the patient has tracheomalacia and requires a tracheostomy, the tube may enter the pouch, causing life-threatening obstruction. ↗
▶ Ep 2 · 1:23:36
quote You can actually lubricate the needle with a copious amount of swear words. I found that really helpful. ↗
▶ Ep 2 · 1:23:36
quote You can actually lubricate the needle with a copious amount of swear words. I found that really helpful. ↗
▶ Ep 2 · 1:24:32
quote If it barks like a dog and it wags its tail, it's probably a dog. ↗
▶ Ep 2 · 1:24:32
quote If it barks like a dog and it wags its tail, it's probably a dog. ↗
▶ Ep 2 · 1:34:43
clinical In patients with retroesophageal subclavian artery, the right recurrent laryngeal nerve is non-recurrent and at higher risk during neck dissection; awareness is critical during transtracheal or slide tracheoplasty approaches. ↗
▶ Ep 2 · 1:34:43
clinical In patients with retroesophageal subclavian artery, the right recurrent laryngeal nerve is non-recurrent and at higher risk during neck dissection; awareness is critical during transtracheal or slide tracheoplasty approaches. ↗
▶ Ep 2 · 1:35:23
clinical After 7 years of aspiration through a TEF, a child may have significant bronchiectasis; repair of the fistula does not immediately resolve lower airway disease, and ongoing chest physiotherapy and airway clearance are required. ↗
▶ Ep 2 · 1:35:23
clinical After 7 years of aspiration through a TEF, a child may have significant bronchiectasis; repair of the fistula does not immediately resolve lower airway disease, and ongoing chest physiotherapy and airway clearance are required. ↗
▶ Ep 2 · 1:37:35
clinical Hearing aid molds are radiolucent and can be missed on chest X-ray; high clinical suspicion is required when a foreign body ingestion is reported but not visualized. ↗
▶ Ep 2 · 1:37:35
clinical Hearing aid molds are radiolucent and can be missed on chest X-ray; high clinical suspicion is required when a foreign body ingestion is reported but not visualized. ↗
▶ Ep 2 · 1:39:49
clinical Pectus excavatum can worsen tracheobronchomalacia; placement of a pectus bar can improve airway support and reduce the need for stenting or tracheostomy. ↗
▶ Ep 2 · 1:39:49
clinical Pectus excavatum can worsen tracheobronchomalacia; placement of a pectus bar can improve airway support and reduce the need for stenting or tracheostomy. ↗
▶ Ep 2 · 1:40:32
clinical Airway stents can erode into the esophagus, creating secondary fistulas; long-term stent management requires vigilance and may necessitate alternative strategies (e.g., Y-stent with tracheostomy tube within the stent). ↗
▶ Ep 2 · 1:40:32
clinical Airway stents can erode into the esophagus, creating secondary fistulas; long-term stent management requires vigilance and may necessitate alternative strategies (e.g., Y-stent with tracheostomy tube within the stent). ↗
▶ Ep 2 · 1:40:56
clinical A Y-shaped airway stent from both bronchi into the trachea, with the tracheostomy tube sitting within the stent, can effectively bypass a bronchoesophageal fistula and allow clinical stability when further repair is not feasible. ↗
▶ Ep 2 · 1:40:56
clinical A Y-shaped airway stent from both bronchi into the trachea, with the tracheostomy tube sitting within the stent, can effectively bypass a bronchoesophageal fistula and allow clinical stability when further repair is not feasible. ↗
▶ Ep 2 · 1:41:24
quote Sometimes the first domino falls, and they just keep falling. ↗
▶ Ep 2 · 1:41:24
quote Sometimes the first domino falls, and they just keep falling. ↗
▶ Ep 2 · 1:47:43
clinical Endoscopic closure of bronchoesophageal fistulas is feasible but challenging; proximity to large vessels (e.g., pulmonary artery branches) may preclude safe cautery and necessitate surgical resection. ↗
▶ Ep 2 · 1:47:43
clinical Endoscopic closure of bronchoesophageal fistulas is feasible but challenging; proximity to large vessels (e.g., pulmonary artery branches) may preclude safe cautery and necessitate surgical resection. ↗
▶ Ep 2 · 1:52:57
quote I'm having a really bad day. ↗
▶ Ep 2 · 1:52:57
quote I'm having a really bad day. ↗
▶ Ep 2 · 1:58:01
clinical Tracheal pouches (diverticula) can be marsupialized endoscopically using a Storz ClickLine laparoscopic biopsy forceps with cautery at 40 watts; the technique is quick, well-tolerated, and eliminates the risk of tracheostomy tube misplacement. ↗
▶ Ep 2 · 1:58:01
clinical Tracheal pouches (diverticula) can be marsupialized endoscopically using a Storz ClickLine laparoscopic biopsy forceps with cautery at 40 watts; the technique is quick, well-tolerated, and eliminates the risk of tracheostomy tube misplacement. ↗

Aerodigestive Management of Pediatric Aspiration - FULL SHOW

▶ Ep 7 · 17:21
clinical A radionucleotide spit scan (placing radioactive tracer on tongue) can test for saliva aspiration but involves radiation and is a one-off window in time. ↗
▶ Ep 7 · 17:21
host_summary A radionucleotide spit scan (placing radioactive tracer on tongue) can test for saliva aspiration but involves radiation and is a one-off window in time. ↗
▶ Ep 7 · 18:05
clinical Impedance probe is the best test for gastroesophageal reflux but is not necessarily widely available. ↗
▶ Ep 7 · 18:05
clinical Impedance probe is the best test for gastroesophageal reflux but is not necessarily widely available. ↗
▶ Ep 7 · 18:31
clinical Medication for reflux generally stops acid but does not stop reflux events. ↗
▶ Ep 7 · 18:31
host_summary Medication for reflux generally stops acid but does not stop reflux events. ↗
▶ Ep 7 · 19:23
clinical CT scanning is excellent for evaluating long-term consequences of aspiration but shows damage already done (tells about the past, not the present) and requires anesthesia, radiation, and radiologic expertise. ↗
▶ Ep 7 · 19:23
clinical CT scanning is excellent for evaluating long-term consequences of aspiration but shows damage already done (tells about the past, not the present) and requires anesthesia, radiation, and radiologic expertise. ↗
▶ Ep 7 · 1:21:41
clinical Laryngotracheal separation guarantees no aspiration but eliminates voice, and attempts to restore voice with speaking valves (Blom-Singer) are not effective in children because the larynx remains in the way—complete laryngectomy with cricopharyngeal myotomy is required for voice restoration. ↗
▶ Ep 7 · 1:21:41
clinical Laryngotracheal separation guarantees no aspiration but eliminates voice, and attempts to restore voice with speaking valves (Blom-Singer) are not effective in children because the larynx remains in the way—complete laryngectomy with cricopharyngeal myotomy is required for voice restoration. ↗
▶ Ep 7 · 1:23:52
clinical The Cincinnati laryngotracheal separation technique involves peeling mucosa up subperichondrially within the cricoid, purse-string closure, splitting cricoid laterally at 3 and 9 o'clock, quilting sutures to sandwich cricoid, tisseal in subglottis, and crisscrossing medial heads of SCM over the laryngeal stump—this has eliminated fistula formation and stomal stenosis. ↗
▶ Ep 7 · 1:23:52
clinical The Cincinnati laryngotracheal separation technique involves peeling mucosa up subperichondrially within the cricoid, purse-string closure, splitting cricoid laterally at 3 and 9 o'clock, quilting sutures to sandwich cricoid, tisseal in subglottis, and crisscrossing medial heads of SCM over the laryngeal stump—this has eliminated fistula formation and stomal stenosis. ↗
▶ Ep 7 · 1:25:19
clinical In children, laryngotracheal separation stomas will stenose without a tube until growth stops, so a relatively big, wide, short tube must remain in the tracheal stoma. ↗
▶ Ep 7 · 1:25:19
clinical In children, laryngotracheal separation stomas will stenose without a tube until growth stops, so a relatively big, wide, short tube must remain in the tracheal stoma. ↗
▶ Ep 7 · 1:32:40
quote Better to skip a tag than to hallucinate a specialty. ↗
▶ Ep 7 · 1:32:40
clinical Tracheoesophageal fistulas can be surprisingly challenging to find and require high index of suspicion, angled telescopes, probing, and positive pressure breath with endotracheal tube in esophagus to visualize bubbling. ↗
▶ Ep 7 · 1:32:40
quote Better to skip a tag than to hallucinate a specialty. ↗
▶ Ep 7 · 1:32:40
clinical Tracheoesophageal fistulas can be surprisingly challenging to find and require high index of suspicion, angled telescopes, probing, and positive pressure breath with endotracheal tube in esophagus to visualize bubbling. ↗
▶ Ep 7 · 1:32:45
quote If you think there's a problem, you've got to go looking for it, be it a TEF or a cleft. ↗
▶ Ep 7 · 1:32:45
quote If you think there's a problem, you've got to go looking for it, be it a TEF or a cleft. ↗
▶ Ep 7 · 1:38:43
clinical Endoscopic TEF repair is ideal for long skinny tracts (usually recurrent TEFs after congenital repair); the concept is to demucosalize the tract with Bugby cautery to get raw-against-raw, inject filler beside the tract to compress it, and place fibrin glue. ↗
▶ Ep 7 · 1:38:43
clinical Endoscopic TEF repair is ideal for long skinny tracts (usually recurrent TEFs after congenital repair); the concept is to demucosalize the tract with Bugby cautery to get raw-against-raw, inject filler beside the tract to compress it, and place fibrin glue. ↗
▶ Ep 7 · 1:39:40
quote Mucosa is a non-stick surface, so you have to remove the mucosa. ↗
▶ Ep 7 · 1:39:40
quote Mucosa is a non-stick surface, so you have to remove the mucosa. ↗
▶ Ep 7 · 1:41:43
quote You should always go in with an index of suspicion in any child who's had a TEF repair and is still aspirating. Is there a laryngeal cleft? ↗
▶ Ep 7 · 1:41:43
quote You should always go in with an index of suspicion in any child who's had a TEF repair and is still aspirating. Is there a laryngeal cleft? ↗
▶ Ep 7 · 1:41:58
quote When the child first has the TEF repaired, that's the time you should be proactively checking for a cleft. ↗
▶ Ep 7 · 1:41:58
quote When the child first has the TEF repaired, that's the time you should be proactively checking for a cleft. ↗
▶ Ep 7 · 1:44:26
clinical Endoscopic TEF repair has a recognized failure rate and surgeons must be prepared to repeat the procedure multiple times. ↗
▶ Ep 7 · 1:44:26
clinical Endoscopic TEF repair has a recognized failure rate and surgeons must be prepared to repeat the procedure multiple times. ↗
▶ Ep 7 · 1:44:26
quote You have to accept with this that you have a failure rate, and you have to be prepared to come back and do it again. ↗
▶ Ep 7 · 1:44:26
quote You have to accept with this that you have a failure rate, and you have to be prepared to come back and do it again. ↗
▶ Ep 7 · 1:46:03
clinical Congenital H-type tracheoesophageal fistulas, with very few exceptions, do not do well with endoscopic repairs and typically require open repair. ↗
▶ Ep 7 · 1:46:03
clinical Congenital H-type tracheoesophageal fistulas, with very few exceptions, do not do well with endoscopic repairs and typically require open repair. ↗
▶ Ep 7 · 1:46:27
clinical For H-type TEFs, the upper 2/3 of trachea is accessible through the neck, the lower third is easier through the chest, and the middle third is no-man's land where whoever has better expertise (pediatric surgery or ENT) should do it. ↗
▶ Ep 7 · 1:46:27
clinical For H-type TEFs, the upper 2/3 of trachea is accessible through the neck, the lower third is easier through the chest, and the middle third is no-man's land where whoever has better expertise (pediatric surgery or ENT) should do it. ↗
▶ Ep 7 · 1:49:45
clinical Slide tracheoplasty technique for large or multiply-failed TEFs involves transecting trachea above and below the hole, peeling trachea off esophagus, using the tracheal segment attached to the hole to repair the esophagus, and reconnecting the trachea over the top with a slide technique that oversizes the airway and reduces tension. ↗
▶ Ep 7 · 1:49:45
clinical Slide tracheoplasty technique for large or multiply-failed TEFs involves transecting trachea above and below the hole, peeling trachea off esophagus, using the tracheal segment attached to the hole to repair the esophagus, and reconnecting the trachea over the top with a slide technique that oversizes the airway and reduces tension. ↗
▶ Ep 7 · 2:00:59
clinical For the case of isolated esophagus with multiple TEFs connecting to trachea, leaving the esophagus isolated at both ends prevents aspiration through the holes while the holes prevent mucocele formation by allowing drainage. ↗
▶ Ep 7 · 2:00:59
clinical For the case of isolated esophagus with multiple TEFs connecting to trachea, leaving the esophagus isolated at both ends prevents aspiration through the holes while the holes prevent mucocele formation by allowing drainage. ↗
▶ Ep 7 · 2:07:00
clinical Flexible bronchoscopy is not a good tool for evaluating posterior laryngeal clefts—rigid bronchoscopy is required for diagnosis. ↗
▶ Ep 7 · 2:07:00
clinical Flexible bronchoscopy is not a good tool for evaluating posterior laryngeal clefts—rigid bronchoscopy is required for diagnosis. ↗
▶ Ep 7 · 2:15:26
clinical For long type 4 clefts, the Cincinnati technique involves transecting trachea at cricoid, peeling trachea off esophagus to beyond the cleft, repairing esophagus, placing sternal periosteum interposition graft, reconnecting trachea, and placing tracheostomy 2-3 weeks later after healing. ↗
▶ Ep 7 · 2:15:26
clinical For long type 4 clefts, the Cincinnati technique involves transecting trachea at cricoid, peeling trachea off esophagus to beyond the cleft, repairing esophagus, placing sternal periosteum interposition graft, reconnecting trachea, and placing tracheostomy 2-3 weeks later after healing. ↗
▶ Ep 7 · 2:17:44
clinical Almost all children under 4 kg who had type 4 cleft repairs died; waiting until the child is over 5 kg improves outcomes. ↗
▶ Ep 7 · 2:17:44
clinical Almost all children under 4 kg who had type 4 cleft repairs died; waiting until the child is over 5 kg improves outcomes. ↗
▶ Ep 7 · 2:19:09
clinical The greatest risk with laryngotracheoesophageal clefts is that the distal end of the repair may form a tracheoesophageal fistula. ↗
▶ Ep 7 · 2:19:09
clinical The greatest risk with laryngotracheoesophageal clefts is that the distal end of the repair may form a tracheoesophageal fistula. ↗
▶ Ep 7 · 2:33:04
clinical For severe pharyngeal stenosis, management is a step ladder approach: voice, breathing without trach, no aspiration, swallowing without G-tube—typically cannot achieve all four, usually one or two steps up the ladder, rarely three. ↗
▶ Ep 7 · 2:33:04
clinical For severe pharyngeal stenosis, management is a step ladder approach: voice, breathing without trach, no aspiration, swallowing without G-tube—typically cannot achieve all four, usually one or two steps up the ladder, rarely three. ↗
▶ Ep 7 · 2:33:41
quote Expectations matter. Counseling the family at the start is important. ↗
▶ Ep 7 · 2:33:41
quote Expectations matter. Counseling the family at the start is important. ↗
▶ Ep 7 · 2:34:27
clinical Composite stents (suprastomal stent with silastic sheet wrapped around it supraglottically) are effective for severe pharyngeal stenosis—the stent goes through vocal cords and locks in trachea while the silastic holds open the supraglottic raw areas during re-mucosalization. ↗
▶ Ep 7 · 2:34:27
clinical Composite stents (suprastomal stent with silastic sheet wrapped around it supraglottically) are effective for severe pharyngeal stenosis—the stent goes through vocal cords and locks in trachea while the silastic holds open the supraglottic raw areas during re-mucosalization. ↗

Laryngeal Clefts

▶ Ep 10 · 0:59
host_summary A laryngeal cleft is a congenital condition in which the posterior wall of the laryngotracheal tract is open and food or liquids can pass from the esophagus into the trachea, leading to aspirations. ↗
▶ Ep 10 · 4:15
host_summary Open approach for laryngeal clefts is reserved for failed endoscopic repair cases, some type 2s and type 3s, using a laryngofissure approach. ↗
▶ Ep 10 · 4:15
host_summary The Cincinnati team does not distinguish between anatomical type 1 cleft versus deep notch for treatment decisions; they care whether the patient is aspirating (physiological cleft). ↗
▶ Ep 10 · 4:15
host_summary For type 4 clefts, a cervical approach is used. ↗
▶ Ep 10 · 4:15
host_summary Type 4 long clefts present anesthetic challenges requiring double lumen tube, single lung ventilation, ECMO or bypass, and often have associated microgastria and multiple congenital anomalies. ↗
▶ Ep 10 · 4:15
host_summary Type 4 long clefts have a very high mortality rate of approximately 50%. ↗
▶ Ep 10 · 4:15
quote We don't care if you've got a type 1 versus a deep notch. We care whether you're aspirating. ↗
▶ Ep 10 · 7:04
quote None of us has been brave enough to tackle a 4 endoscopically yet. ↗
▶ Ep 10 · 7:04
host_summary Most type 3 clefts are attempted endoscopically unless there is a reason to go open. ↗
▶ Ep 10 · 7:04
host_summary The transtracheal technique for type 4 clefts involves forming layers between trachea and esophagus, sewing the esophageal layer with knots in lumen, sewing the tracheal layer with knots in lumen, with optional interposition graft. ↗
▶ Ep 10 · 8:53
host_summary The novel surgical technique for type 4 long clefts involves transecting the trachea at the lower border of the cricoid, peeling the trachea off the esophagus beyond the cleft while keeping the patient intubated into one bronchus, repairing the esophagus with optional second imbricating layer, placing an interposition graft (typically sternal or tibial periosteum), reconnecting the trachea to the cricoid, and placing a tracheostomy relatively late at two or three weeks. ↗
▶ Ep 10 · 10:16
host_summary For the type 4 long cleft case, the team waited three months until the child was greater than 5 kilograms based on outcomes data from previous research. ↗
▶ Ep 10 · 10:16
host_summary Residual tracheoesophageal fistula can be repaired endoscopically using bugbee cautery to demucosalize the tract followed by endoscopic suture placement with P2 needle on 4-0 PDS to create raw-against-raw closure. ↗
▶ Ep 10 · 10:16
host_summary The biggest risk with laryngotracheal esophageal clefts is that the distal end turns into a tracheoesophageal fistula. ↗
▶ Ep 10 · 10:16
host_summary When placing an endotracheal tube for type 4 long cleft repair, think big, like 4.5 size. ↗

Laryngotracheal Stenosis

▶ Ep 12 · 1:34
quote In the 21st century, we're seeing a resurgence of interest in endoscopic airway surgery, and this often complements open surgery. Some patients still need the open airway operations, and deciding who to offer what operation, that's the first step. ↗
▶ Ep 12 · 1:34
clinical The development of open airway surgery in the 1970s allowed for costocartilage grafts and laryngotracheal reconstruction. ↗
▶ Ep 12 · 1:34
clinical Prior to the 1970s, bougie dilation using progressively larger dilators was the mainstay of airway stenosis management but caused significant shear forces and mucosal damage. ↗
▶ Ep 12 · 1:34
clinical In the 21st century, endoscopic airway surgery is experiencing a resurgence and often complements open surgery. ↗
▶ Ep 12 · 1:34
quote You had a stenosis, you put through a small dilator, cat tail dilator, a bougie, a endotracheal tube, and then you put a slightly bigger one through, and then a bigger one through, and you slowly stretch up the stenosis. A lot of shear forces, quite a lot of mucosal damage. And so this wasn't enormously successful, but it was the best that we had for a long time. ↗
▶ Ep 12 · 4:26
clinical The balloon is inflated to rated burst pressure and held for two minutes or until oxygen saturations drop to 90%, whichever happens first. ↗
▶ Ep 12 · 5:26
clinical When dilating a balloon in a stenosis, pressure keeps dropping for about 90 seconds as the fibrous tissue is stretched open, requiring continuous addition of water to the syringe pump. ↗
▶ Ep 12 · 5:26
quote The reason for the two minutes is if you dilate a balloon on a bench, it goes to pressure and stays there. If you dilate it in a stenosis, you keep having to add water to the syringe pump as the pressure keeps dropping for about 90 seconds as the fibrous tissue is stretched open. ↗
▶ Ep 12 · 7:04
clinical Kenalog injection with orotracheal injector set followed by division of scar bands in a Mercedes-Star incision with a blitzer knife is used as an adjunctive procedure. ↗
▶ Ep 12 · 7:33
quote The technique I like to do is to place it with the point away from the airway, get it into the stenosis, and then turn it 180 degrees and cut towards the lumen. You get a much better result. ↗
▶ Ep 12 · 7:33
clinical The technique for scar division is to place the blitzer knife with the point away from the airway, get it into the stenosis, turn it 180 degrees and cut towards the lumen for a better result. ↗
▶ Ep 12 · 7:48
clinical Endoscopic dilation works for stenosis at multiple levels - if you can do it in the larynx, you can do it in the trachea. ↗
▶ Ep 12 · 8:03
quote If you can do it in the larynx, you can do it in the trachea. ↗
▶ Ep 12 · 8:56
opinion Current knowledge gaps include what size balloon to select, how much pressure is appropriate, how long to leave it inflated, when to repeat it, how often to repeat it, who should not be dilated, and when to use adjunctive procedures. ↗
▶ Ep 12 · 8:56
quote We don't know what size balloon to select. We don't know how much pressure is appropriate to put in that balloon. We don't know how long to leave it inflated, when to repeat it, how often to repeat it, who we shouldn't dilate, and when to use adjunctive procedures. ↗
▶ Ep 12 · 9:33
quote The protocol for dilation, we usually dilate three or four times at seven to ten day intervals for established scar. ↗
▶ Ep 12 · 9:33
guideline If after five dilations you are not winning, you should take a step back and think about doing something else. ↗
▶ Ep 12 · 9:33
guideline On the second dilation, adjunctive procedures may include Kenalog injection, scar tissue division, increasing balloon size, or nebulizing cipridex if there are significant raw areas after dilation. ↗
▶ Ep 12 · 9:33
guideline The protocol for dilation is usually three or four times at seven to ten day intervals for established scar. ↗
▶ Ep 12 · 9:33
quote And if after five dilations, you are not winning, you should take a step back and think, should I be doing something else? ↗
▶ Ep 12 · 10:28
clinical The ideal candidate for balloon dilation has thin scar and young scar; thicker or established scar may require adjunctive procedures like scar division or steroid injection. ↗
▶ Ep 12 · 10:28
quote The ideal candidate, thin scar, young scar. And if it's something that's a little thicker or quite established, that's when you may want to think about adjunctive procedures, scar division, steroid injection, for example. ↗
▶ Ep 12 · 10:55
guideline The formula for balloon sizing is to take the outer diameter of an age-appropriate endotracheal tube and add one millimeter for the larynx or two millimeters for the trachea. ↗
▶ Ep 12 · 10:55
quote The formula I used was you take the outer diameter of an age-appropriate and tracheal tube. You add one millimeter for luck for the larynx and two millimeters for luck for the trachea. ↗
▶ Ep 12 · 11:17
clinical A free app has been developed to help choose the right size balloon to minimize risk. ↗
▶ Ep 12 · 12:58
clinical The open procedure involves harvesting rib, exposing the larynx, placing vocal cord spreaders, dividing the posterior cricoid with a sickle knife and micro scissors, and may require dividing the inter-arytenoid muscle. ↗
▶ Ep 12 · 12:58
clinical Open airway reconstruction requires an easily exposed larynx and is easier in a patient with a tracheotomy, but not required as long as the child can be kept spontaneously breathing under anesthesia. ↗
▶ Ep 12 · 13:39
clinical A balloon can be placed anteriorly and inflated to push the cartilage graft into place during open reconstruction. ↗
▶ Ep 12 · 14:47
clinical After dividing web scar tissue with a sickle knife, a keel must be placed to prevent raw mucosal surfaces from re-adhering. ↗
▶ Ep 12 · 14:47
clinical For minor laryngeal webs, endoscopic repair is feasible and does not necessarily require a tracheotomy tube. ↗
▶ Ep 12 · 15:01
clinical The keel placement technique uses a keith needle threaded through silastic, taken out using a hollow angiocath as a guide. ↗
▶ Ep 12 · 15:21
clinical The keel is kept in place for 10 days to allow tissue to re-mucosalize without re-adherence or risk of re-stenosis from scar tissue. ↗

QUAD #6 Slide Tracheoplasty for TEF, Otolaryngology Approach with Dr. Mike Rutter

▶ Ep 19 · 0:49
clinical Slide tracheoplasty can be used as a method of repairing challenging tracheoesophageal fistulas ↗
▶ Ep 19 · 1:03
quote You've got a very tight ring segment with a fistula behind the ring segment, and you can see how narrow the distal trachea is. ↗
▶ Ep 19 · 1:11
quote We went on and repaired both at the same time because we really didn't have an option ↗
▶ Ep 19 · 1:11
clinical In a case with complete tracheal rings and TEF, both conditions were repaired simultaneously because there was no other option ↗
▶ Ep 19 · 1:25
quote The technique is that we basically transect the trachea above and below the hole with a sort of a bevel, so we're not losing too much trachea. ↗
▶ Ep 19 · 1:25
clinical The slide tracheoplasty technique involves transecting the trachea above and below the hole with a bevel to avoid losing too much trachea ↗
▶ Ep 19 · 1:35
clinical Part of the trachea is used to repair the esophagus, then the trachea is slid over the top of it, often with a periosteal interposition graft ↗
▶ Ep 19 · 1:35
quote Use part of the trachea to repair the esophagus, slide the trachea over the top of it, quite often with a little interposition graft of periosteum. ↗
▶ Ep 19 · 1:54
quote She's had thoracotomies, tracheal resections, flaps, because they couldn't get rid of the hole, they just left a T tube in place and, and she aspirates chronically. ↗
▶ Ep 19 · 2:18
quote And so this is a slight tracheoplasty technique, and you can see the bougie in the esophagus, we've transected the trachea above and below, and we're sewing this flap of trachea onto the esophagus, so the front wall of the esophagus is now gonna be a piece of trachea, just a a quick running suture technique with 4 OPDS. ↗
▶ Ep 19 · 2:18
clinical In the slide tracheoplasty repair, a flap of trachea is sewn onto the esophagus so the front wall of the esophagus becomes a piece of trachea, using a quick running suture technique with 4-0 PDS ↗
▶ Ep 19 · 2:47
quote And so if you use nerve hooks and you just take your time slowly tightening up the multiple throws you've already done, it slowly comes together. ↗
▶ Ep 19 · 2:47
clinical When the distance between trachea and esophagus is large, using nerve hooks and slowly tightening multiple throws brings the structures together ↗
▶ Ep 19 · 3:08
clinical In the Swedish patient case, esophagoscopy at one month post-op showed the suture line where trachea was sewn to esophagus with the front wall being a piece of trachea ↗
▶ Ep 19 · 3:24
clinical The Swedish patient returned to eating and drinking everything despite having a very short trachea ↗
▶ Ep 19 · 3:24
quote She went back to Sweden, she's eating and drinking everything, she's got a really short trachea, and she's doing fine. ↗
▶ Ep 19 · 3:44
quote She was referred to us aspirating on high flow with a chest tube in place. ↗
▶ Ep 19 · 4:05
quote There's suture material everywhere to the point you don't actually know where the lumen is in the esophagus. ↗
▶ Ep 19 · 4:23
clinical In the 4-year-old case, initial stabilization was achieved by placing an esophageal stent, which did not fix the holes but eliminated the mediastinal communication ↗
▶ Ep 19 · 4:23
quote She's had two thoracotomies, you couldn't mobilize her esophagus, and so we stabilized her initially by putting in an esophageal stent, bought her some time, that didn't fix the holes, but got rid of the mediastinal communication. ↗
▶ Ep 19 · 4:50
quote You get fantastic exposure to the esophagus. ↗
▶ Ep 19 · 4:50
clinical A transsternal, transtracheal approach provides fantastic exposure to the esophagus ↗
▶ Ep 19 · 4:55
quote We went transternal, transtracheal, and we took a little bit of tibial periosteum as a nice interposition graft. ↗
▶ Ep 19 · 4:55
clinical Tibial periosteum serves as a good interposition graft ↗
▶ Ep 19 · 5:05
quote Periosteum is really good at protecting one lumen from another. ↗
▶ Ep 19 · 5:05
clinical Periosteum is effective at protecting one lumen from another ↗
▶ Ep 19 · 6:14
quote For challenging tracheoesophageal fistulas, a slight tracheoplasty can be a very valuable addition to the options available for repair. ↗
▶ Ep 19 · 6:26
opinion Slide tracheoplasty is not appropriate for every TEF case, but it is useful to know the option is available ↗
▶ Ep 19 · 6:26
quote You're not gonna do this for everyone, it's just useful knowing that there are options available. ↗
CHARGE Syndrome 87 entries

Aerodigestive & Esophageal Surgery - Difficult Tracheal Esophageal Fistula

▶ Ep 1 · 4:39
clinical Most children who aspirate have a functional or neurological problem (cerebral palsy, CHARGE syndrome); some have anatomical problems (TEF, laryngeal cleft, pharyngeal scar, esophageal stenosis). ↗
▶ Ep 1 · 4:39
clinical Most children who aspirate have a functional or neurological problem (cerebral palsy, CHARGE syndrome); some have anatomical problems (TEF, laryngeal cleft, pharyngeal scar, esophageal stenosis). ↗
▶ Ep 1 · 12:10
clinical A 3-French bugbee cautery is a smooth, excellent probe for identifying subtle tracheoesophageal fistulas. ↗
▶ Ep 1 · 12:10
clinical A 3-French bugbee cautery is a smooth, excellent probe for identifying subtle tracheoesophageal fistulas. ↗
▶ Ep 1 · 13:21
clinical A 70-degree endoscope is a difficult tool to use but can visualize TEFs that are otherwise hard to see with standard forward-viewing scopes. ↗
▶ Ep 1 · 13:21
clinical A 70-degree endoscope is a difficult tool to use but can visualize TEFs that are otherwise hard to see with standard forward-viewing scopes. ↗
▶ Ep 1 · 14:51
clinical Pediatric surgery fellows at Cincinnati Children's complete a one-month attachment with ENT to perform bronchoscopies and gain airway expertise. ↗
▶ Ep 1 · 14:51
clinical Pediatric surgery fellows at Cincinnati Children's complete a one-month attachment with ENT to perform bronchoscopies and gain airway expertise. ↗
▶ Ep 1 · 23:41
clinical Endoscopic TEF closure requires demucosalization of the tract (mucosa is a non-stick surface); the goal is raw-against-raw apposition with minimal fibrin glue (0.1 mL) to seal the tract while scarring occurs. ↗
▶ Ep 1 · 23:41
clinical Endoscopic TEF closure requires demucosalization of the tract (mucosa is a non-stick surface); the goal is raw-against-raw apposition with minimal fibrin glue (0.1 mL) to seal the tract while scarring occurs. ↗
▶ Ep 1 · 30:20
quote You don't want to give the mucosa a fright, you want to destroy it. ↗
▶ Ep 1 · 30:20
quote You don't want to give the mucosa a fright, you want to destroy it. ↗
▶ Ep 1 · 34:20
clinical Positive-pressure air insufflation (30 cm H₂O) via an endotracheal tube in the esophagus can reveal a TEF by causing air to bubble out of the tracheal opening. ↗
▶ Ep 1 · 34:20
clinical Positive-pressure air insufflation (30 cm H₂O) via an endotracheal tube in the esophagus can reveal a TEF by causing air to bubble out of the tracheal opening. ↗
▶ Ep 1 · 37:01
clinical Endoscopic TEF repair success rate is approximately 80%, typically requiring 2 attempts; after 3–4 failed attempts, open repair should be considered. ↗
▶ Ep 1 · 37:01
clinical Endoscopic TEF repair success rate is approximately 80%, typically requiring 2 attempts; after 3–4 failed attempts, open repair should be considered. ↗
▶ Ep 1 · 38:35
clinical When cauterizing in the airway with a bugbee, oxygen concentration should be kept below 30% to minimize fire risk; brief periods of lower oxygen saturation are tolerable. ↗
▶ Ep 1 · 38:35
clinical When cauterizing in the airway with a bugbee, oxygen concentration should be kept below 30% to minimize fire risk; brief periods of lower oxygen saturation are tolerable. ↗
▶ Ep 1 · 39:48
clinical Injection of an inert material (e.g., Radiesse voice gel) into the walls adjacent to a TEF tract can obliterate the potential space and promote raw-on-raw apposition; the material is absorbed over a few weeks. ↗
▶ Ep 1 · 39:48
clinical Injection of an inert material (e.g., Radiesse voice gel) into the walls adjacent to a TEF tract can obliterate the potential space and promote raw-on-raw apposition; the material is absorbed over a few weeks. ↗
▶ Ep 1 · 45:48
clinical Slide tracheoplasty for TEF involves transecting the trachea above and below the fistula, beveling the edges, turning in the tracheal wings to repair the esophagus, interposing sternal periosteum, and reconnecting the trachea; it is a three-layer repair. ↗
▶ Ep 1 · 45:48
clinical Slide tracheoplasty for TEF involves transecting the trachea above and below the fistula, beveling the edges, turning in the tracheal wings to repair the esophagus, interposing sternal periosteum, and reconnecting the trachea; it is a three-layer repair. ↗
▶ Ep 1 · 46:52
clinical Sternal periosteum is an excellent interposition graft material: it is abundant, in the surgical field, and extremely strong ('like Kevlar'), though difficult to suture. ↗
▶ Ep 1 · 46:52
clinical Sternal periosteum is an excellent interposition graft material: it is abundant, in the surgical field, and extremely strong ('like Kevlar'), though difficult to suture. ↗
▶ Ep 1 · 53:37
guideline Button batteries can cause ongoing tissue injury for weeks after ingestion, even if 'dead' (they retain ~2 volts); institutional protocol mandates removal within 2 hours of identification. ↗
▶ Ep 1 · 53:37
guideline Button batteries can cause ongoing tissue injury for weeks after ingestion, even if 'dead' (they retain ~2 volts); institutional protocol mandates removal within 2 hours of identification. ↗
▶ Ep 1 · 54:02
clinical Two slide tracheoplasty repairs for button battery TEF both dehisced (one at 10 days, one at 3 months); both were successfully revised. This may be more than coincidence, suggesting button battery injuries pose unique challenges. ↗
▶ Ep 1 · 54:02
clinical Two slide tracheoplasty repairs for button battery TEF both dehisced (one at 10 days, one at 3 months); both were successfully revised. This may be more than coincidence, suggesting button battery injuries pose unique challenges. ↗
▶ Ep 1 · 1:04:43
clinical Transtracheal repair technique: anterior tracheotomy, identify the fistula from within the trachea, separate tracheal and esophageal layers, three-layer closure (esophageal mucosa with knots in lumen, sternal periosteum, tracheal wall with knots in lumen). ↗
▶ Ep 1 · 1:04:43
clinical Transtracheal repair technique: anterior tracheotomy, identify the fistula from within the trachea, separate tracheal and esophageal layers, three-layer closure (esophageal mucosa with knots in lumen, sternal periosteum, tracheal wall with knots in lumen). ↗
▶ Ep 1 · 1:09:04
opinion Transtracheal TEF repair is a two-dimensional operation with lower complication risk than slide tracheoplasty; the primary complication is re-fistulization, whereas slide tracheoplasty dehiscence is a more serious event. ↗
▶ Ep 1 · 1:09:04
opinion Transtracheal TEF repair is a two-dimensional operation with lower complication risk than slide tracheoplasty; the primary complication is re-fistulization, whereas slide tracheoplasty dehiscence is a more serious event. ↗
▶ Ep 1 · 1:09:59
opinion Slide tracheoplasty appears to be a learning-curve, surgeon-dependent operation; revision cases have been necessary as experience was gained. ↗
▶ Ep 1 · 1:09:59
opinion Slide tracheoplasty appears to be a learning-curve, surgeon-dependent operation; revision cases have been necessary as experience was gained. ↗
▶ Ep 1 · 1:17:21
clinical When repairing a high TEF from a thoracic approach, ligation of the fistula on the esophageal side can leave a large tracheal pouch; if the patient has tracheomalacia and requires a tracheostomy, the tube may enter the pouch, causing life-threatening obstruction. ↗
▶ Ep 1 · 1:17:21
clinical When repairing a high TEF from a thoracic approach, ligation of the fistula on the esophageal side can leave a large tracheal pouch; if the patient has tracheomalacia and requires a tracheostomy, the tube may enter the pouch, causing life-threatening obstruction. ↗
▶ Ep 1 · 1:23:36
quote You can actually lubricate the needle with a copious amount of swear words. I found that really helpful. ↗
▶ Ep 1 · 1:23:36
quote You can actually lubricate the needle with a copious amount of swear words. I found that really helpful. ↗
▶ Ep 1 · 1:24:32
quote If it barks like a dog and it wags its tail, it's probably a dog. ↗
▶ Ep 1 · 1:24:32
quote If it barks like a dog and it wags its tail, it's probably a dog. ↗
▶ Ep 1 · 1:34:43
clinical In patients with retroesophageal subclavian artery, the right recurrent laryngeal nerve is non-recurrent and at higher risk during neck dissection; awareness is critical during transtracheal or slide tracheoplasty approaches. ↗
▶ Ep 1 · 1:34:43
clinical In patients with retroesophageal subclavian artery, the right recurrent laryngeal nerve is non-recurrent and at higher risk during neck dissection; awareness is critical during transtracheal or slide tracheoplasty approaches. ↗
▶ Ep 1 · 1:35:23
clinical After 7 years of aspiration through a TEF, a child may have significant bronchiectasis; repair of the fistula does not immediately resolve lower airway disease, and ongoing chest physiotherapy and airway clearance are required. ↗
▶ Ep 1 · 1:35:23
clinical After 7 years of aspiration through a TEF, a child may have significant bronchiectasis; repair of the fistula does not immediately resolve lower airway disease, and ongoing chest physiotherapy and airway clearance are required. ↗
▶ Ep 1 · 1:37:35
clinical Hearing aid molds are radiolucent and can be missed on chest X-ray; high clinical suspicion is required when a foreign body ingestion is reported but not visualized. ↗
▶ Ep 1 · 1:37:35
clinical Hearing aid molds are radiolucent and can be missed on chest X-ray; high clinical suspicion is required when a foreign body ingestion is reported but not visualized. ↗
▶ Ep 1 · 1:39:49
clinical Pectus excavatum can worsen tracheobronchomalacia; placement of a pectus bar can improve airway support and reduce the need for stenting or tracheostomy. ↗
▶ Ep 1 · 1:39:49
clinical Pectus excavatum can worsen tracheobronchomalacia; placement of a pectus bar can improve airway support and reduce the need for stenting or tracheostomy. ↗
▶ Ep 1 · 1:40:32
clinical Airway stents can erode into the esophagus, creating secondary fistulas; long-term stent management requires vigilance and may necessitate alternative strategies (e.g., Y-stent with tracheostomy tube within the stent). ↗
▶ Ep 1 · 1:40:32
clinical Airway stents can erode into the esophagus, creating secondary fistulas; long-term stent management requires vigilance and may necessitate alternative strategies (e.g., Y-stent with tracheostomy tube within the stent). ↗
▶ Ep 1 · 1:40:56
clinical A Y-shaped airway stent from both bronchi into the trachea, with the tracheostomy tube sitting within the stent, can effectively bypass a bronchoesophageal fistula and allow clinical stability when further repair is not feasible. ↗
▶ Ep 1 · 1:40:56
clinical A Y-shaped airway stent from both bronchi into the trachea, with the tracheostomy tube sitting within the stent, can effectively bypass a bronchoesophageal fistula and allow clinical stability when further repair is not feasible. ↗
▶ Ep 1 · 1:41:24
quote Sometimes the first domino falls, and they just keep falling. ↗
▶ Ep 1 · 1:41:24
quote Sometimes the first domino falls, and they just keep falling. ↗
▶ Ep 1 · 1:47:43
clinical Endoscopic closure of bronchoesophageal fistulas is feasible but challenging; proximity to large vessels (e.g., pulmonary artery branches) may preclude safe cautery and necessitate surgical resection. ↗
▶ Ep 1 · 1:47:43
clinical Endoscopic closure of bronchoesophageal fistulas is feasible but challenging; proximity to large vessels (e.g., pulmonary artery branches) may preclude safe cautery and necessitate surgical resection. ↗
▶ Ep 1 · 1:52:57
quote I'm having a really bad day. ↗
▶ Ep 1 · 1:52:57
quote I'm having a really bad day. ↗
▶ Ep 1 · 1:58:01
clinical Tracheal pouches (diverticula) can be marsupialized endoscopically using a Storz ClickLine laparoscopic biopsy forceps with cautery at 40 watts; the technique is quick, well-tolerated, and eliminates the risk of tracheostomy tube misplacement. ↗
▶ Ep 1 · 1:58:01
clinical Tracheal pouches (diverticula) can be marsupialized endoscopically using a Storz ClickLine laparoscopic biopsy forceps with cautery at 40 watts; the technique is quick, well-tolerated, and eliminates the risk of tracheostomy tube misplacement. ↗

Aerodigestive Management of Pediatric Aspiration - FULL SHOW

▶ Ep 2 · 17:21
host_summary A radionucleotide spit scan (placing radioactive tracer on tongue) can test for saliva aspiration but involves radiation and is a one-off window in time. ↗
▶ Ep 2 · 18:05
clinical Impedance probe is the best test for gastroesophageal reflux but is not necessarily widely available. ↗
▶ Ep 2 · 18:31
host_summary Medication for reflux generally stops acid but does not stop reflux events. ↗
▶ Ep 2 · 19:23
clinical CT scanning is excellent for evaluating long-term consequences of aspiration but shows damage already done (tells about the past, not the present) and requires anesthesia, radiation, and radiologic expertise. ↗
▶ Ep 2 · 1:21:41
clinical Laryngotracheal separation guarantees no aspiration but eliminates voice, and attempts to restore voice with speaking valves (Blom-Singer) are not effective in children because the larynx remains in the way—complete laryngectomy with cricopharyngeal myotomy is required for voice restoration. ↗
▶ Ep 2 · 1:23:52
clinical The Cincinnati laryngotracheal separation technique involves peeling mucosa up subperichondrially within the cricoid, purse-string closure, splitting cricoid laterally at 3 and 9 o'clock, quilting sutures to sandwich cricoid, tisseal in subglottis, and crisscrossing medial heads of SCM over the laryngeal stump—this has eliminated fistula formation and stomal stenosis. ↗
▶ Ep 2 · 1:25:19
clinical In children, laryngotracheal separation stomas will stenose without a tube until growth stops, so a relatively big, wide, short tube must remain in the tracheal stoma. ↗
▶ Ep 2 · 1:32:40
quote Better to skip a tag than to hallucinate a specialty. ↗
▶ Ep 2 · 1:32:40
clinical Tracheoesophageal fistulas can be surprisingly challenging to find and require high index of suspicion, angled telescopes, probing, and positive pressure breath with endotracheal tube in esophagus to visualize bubbling. ↗
▶ Ep 2 · 1:32:45
quote If you think there's a problem, you've got to go looking for it, be it a TEF or a cleft. ↗
▶ Ep 2 · 1:38:43
clinical Endoscopic TEF repair is ideal for long skinny tracts (usually recurrent TEFs after congenital repair); the concept is to demucosalize the tract with Bugby cautery to get raw-against-raw, inject filler beside the tract to compress it, and place fibrin glue. ↗
▶ Ep 2 · 1:39:40
quote Mucosa is a non-stick surface, so you have to remove the mucosa. ↗
▶ Ep 2 · 1:41:43
quote You should always go in with an index of suspicion in any child who's had a TEF repair and is still aspirating. Is there a laryngeal cleft? ↗
▶ Ep 2 · 1:41:58
quote When the child first has the TEF repaired, that's the time you should be proactively checking for a cleft. ↗
▶ Ep 2 · 1:44:26
clinical Endoscopic TEF repair has a recognized failure rate and surgeons must be prepared to repeat the procedure multiple times. ↗
▶ Ep 2 · 1:44:26
quote You have to accept with this that you have a failure rate, and you have to be prepared to come back and do it again. ↗
▶ Ep 2 · 1:46:03
clinical Congenital H-type tracheoesophageal fistulas, with very few exceptions, do not do well with endoscopic repairs and typically require open repair. ↗
▶ Ep 2 · 1:46:27
clinical For H-type TEFs, the upper 2/3 of trachea is accessible through the neck, the lower third is easier through the chest, and the middle third is no-man's land where whoever has better expertise (pediatric surgery or ENT) should do it. ↗
▶ Ep 2 · 1:49:45
clinical Slide tracheoplasty technique for large or multiply-failed TEFs involves transecting trachea above and below the hole, peeling trachea off esophagus, using the tracheal segment attached to the hole to repair the esophagus, and reconnecting the trachea over the top with a slide technique that oversizes the airway and reduces tension. ↗
▶ Ep 2 · 2:00:59
clinical For the case of isolated esophagus with multiple TEFs connecting to trachea, leaving the esophagus isolated at both ends prevents aspiration through the holes while the holes prevent mucocele formation by allowing drainage. ↗
▶ Ep 2 · 2:07:00
clinical Flexible bronchoscopy is not a good tool for evaluating posterior laryngeal clefts—rigid bronchoscopy is required for diagnosis. ↗
▶ Ep 2 · 2:15:26
clinical For long type 4 clefts, the Cincinnati technique involves transecting trachea at cricoid, peeling trachea off esophagus to beyond the cleft, repairing esophagus, placing sternal periosteum interposition graft, reconnecting trachea, and placing tracheostomy 2-3 weeks later after healing. ↗
▶ Ep 2 · 2:17:44
clinical Almost all children under 4 kg who had type 4 cleft repairs died; waiting until the child is over 5 kg improves outcomes. ↗
▶ Ep 2 · 2:19:09
clinical The greatest risk with laryngotracheoesophageal clefts is that the distal end of the repair may form a tracheoesophageal fistula. ↗
▶ Ep 2 · 2:33:04
clinical For severe pharyngeal stenosis, management is a step ladder approach: voice, breathing without trach, no aspiration, swallowing without G-tube—typically cannot achieve all four, usually one or two steps up the ladder, rarely three. ↗
▶ Ep 2 · 2:33:41
quote Expectations matter. Counseling the family at the start is important. ↗
▶ Ep 2 · 2:34:27
clinical Composite stents (suprastomal stent with silastic sheet wrapped around it supraglottically) are effective for severe pharyngeal stenosis—the stent goes through vocal cords and locks in trachea while the silastic holds open the supraglottic raw areas during re-mucosalization. ↗
Esophageal Atresia 30 entries

Aerodigestive & Esophageal Surgery - Difficult Tracheal Esophageal Fistula

▶ Ep 6 · 4:39
clinical Most children who aspirate have a functional or neurological problem (cerebral palsy, CHARGE syndrome); some have anatomical problems (TEF, laryngeal cleft, pharyngeal scar, esophageal stenosis). ↗
▶ Ep 6 · 12:10
clinical A 3-French bugbee cautery is a smooth, excellent probe for identifying subtle tracheoesophageal fistulas. ↗
▶ Ep 6 · 13:21
clinical A 70-degree endoscope is a difficult tool to use but can visualize TEFs that are otherwise hard to see with standard forward-viewing scopes. ↗
▶ Ep 6 · 14:51
clinical Pediatric surgery fellows at Cincinnati Children's complete a one-month attachment with ENT to perform bronchoscopies and gain airway expertise. ↗
▶ Ep 6 · 23:41
clinical Endoscopic TEF closure requires demucosalization of the tract (mucosa is a non-stick surface); the goal is raw-against-raw apposition with minimal fibrin glue (0.1 mL) to seal the tract while scarring occurs. ↗
▶ Ep 6 · 30:20
quote You don't want to give the mucosa a fright, you want to destroy it. ↗
▶ Ep 6 · 34:20
clinical Positive-pressure air insufflation (30 cm H₂O) via an endotracheal tube in the esophagus can reveal a TEF by causing air to bubble out of the tracheal opening. ↗
▶ Ep 6 · 37:01
clinical Endoscopic TEF repair success rate is approximately 80%, typically requiring 2 attempts; after 3–4 failed attempts, open repair should be considered. ↗
▶ Ep 6 · 38:35
clinical When cauterizing in the airway with a bugbee, oxygen concentration should be kept below 30% to minimize fire risk; brief periods of lower oxygen saturation are tolerable. ↗
▶ Ep 6 · 39:48
clinical Injection of an inert material (e.g., Radiesse voice gel) into the walls adjacent to a TEF tract can obliterate the potential space and promote raw-on-raw apposition; the material is absorbed over a few weeks. ↗
▶ Ep 6 · 45:48
clinical Slide tracheoplasty for TEF involves transecting the trachea above and below the fistula, beveling the edges, turning in the tracheal wings to repair the esophagus, interposing sternal periosteum, and reconnecting the trachea; it is a three-layer repair. ↗
▶ Ep 6 · 46:52
clinical Sternal periosteum is an excellent interposition graft material: it is abundant, in the surgical field, and extremely strong ('like Kevlar'), though difficult to suture. ↗
▶ Ep 6 · 53:37
guideline Button batteries can cause ongoing tissue injury for weeks after ingestion, even if 'dead' (they retain ~2 volts); institutional protocol mandates removal within 2 hours of identification. ↗
▶ Ep 6 · 54:02
clinical Two slide tracheoplasty repairs for button battery TEF both dehisced (one at 10 days, one at 3 months); both were successfully revised. This may be more than coincidence, suggesting button battery injuries pose unique challenges. ↗
▶ Ep 6 · 1:04:43
clinical Transtracheal repair technique: anterior tracheotomy, identify the fistula from within the trachea, separate tracheal and esophageal layers, three-layer closure (esophageal mucosa with knots in lumen, sternal periosteum, tracheal wall with knots in lumen). ↗
▶ Ep 6 · 1:09:04
opinion Transtracheal TEF repair is a two-dimensional operation with lower complication risk than slide tracheoplasty; the primary complication is re-fistulization, whereas slide tracheoplasty dehiscence is a more serious event. ↗
▶ Ep 6 · 1:09:59
opinion Slide tracheoplasty appears to be a learning-curve, surgeon-dependent operation; revision cases have been necessary as experience was gained. ↗
▶ Ep 6 · 1:17:21
clinical When repairing a high TEF from a thoracic approach, ligation of the fistula on the esophageal side can leave a large tracheal pouch; if the patient has tracheomalacia and requires a tracheostomy, the tube may enter the pouch, causing life-threatening obstruction. ↗
▶ Ep 6 · 1:23:36
quote You can actually lubricate the needle with a copious amount of swear words. I found that really helpful. ↗
▶ Ep 6 · 1:24:32
quote If it barks like a dog and it wags its tail, it's probably a dog. ↗
▶ Ep 6 · 1:34:43
clinical In patients with retroesophageal subclavian artery, the right recurrent laryngeal nerve is non-recurrent and at higher risk during neck dissection; awareness is critical during transtracheal or slide tracheoplasty approaches. ↗
▶ Ep 6 · 1:35:23
clinical After 7 years of aspiration through a TEF, a child may have significant bronchiectasis; repair of the fistula does not immediately resolve lower airway disease, and ongoing chest physiotherapy and airway clearance are required. ↗
▶ Ep 6 · 1:37:35
clinical Hearing aid molds are radiolucent and can be missed on chest X-ray; high clinical suspicion is required when a foreign body ingestion is reported but not visualized. ↗
▶ Ep 6 · 1:39:49
clinical Pectus excavatum can worsen tracheobronchomalacia; placement of a pectus bar can improve airway support and reduce the need for stenting or tracheostomy. ↗
▶ Ep 6 · 1:40:32
clinical Airway stents can erode into the esophagus, creating secondary fistulas; long-term stent management requires vigilance and may necessitate alternative strategies (e.g., Y-stent with tracheostomy tube within the stent). ↗
▶ Ep 6 · 1:40:56
clinical A Y-shaped airway stent from both bronchi into the trachea, with the tracheostomy tube sitting within the stent, can effectively bypass a bronchoesophageal fistula and allow clinical stability when further repair is not feasible. ↗
▶ Ep 6 · 1:41:24
quote Sometimes the first domino falls, and they just keep falling. ↗
▶ Ep 6 · 1:47:43
clinical Endoscopic closure of bronchoesophageal fistulas is feasible but challenging; proximity to large vessels (e.g., pulmonary artery branches) may preclude safe cautery and necessitate surgical resection. ↗
▶ Ep 6 · 1:52:57
quote I'm having a really bad day. ↗
▶ Ep 6 · 1:58:01
clinical Tracheal pouches (diverticula) can be marsupialized endoscopically using a Storz ClickLine laparoscopic biopsy forceps with cautery at 40 watts; the technique is quick, well-tolerated, and eliminates the risk of tracheostomy tube misplacement. ↗
Laryngeal Cleft 15 entries

Laryngeal Clefts

▶ Ep 1 · 0:59
host_summary A laryngeal cleft is a congenital condition in which the posterior wall of the laryngotracheal tract is open and food or liquids can pass from the esophagus into the trachea, leading to aspirations. ↗
▶ Ep 1 · 4:15
host_summary The Cincinnati team does not distinguish between anatomical type 1 cleft versus deep notch for treatment decisions; they care whether the patient is aspirating (physiological cleft). ↗
▶ Ep 1 · 4:15
quote We don't care if you've got a type 1 versus a deep notch. We care whether you're aspirating. ↗
▶ Ep 1 · 4:15
host_summary Open approach for laryngeal clefts is reserved for failed endoscopic repair cases, some type 2s and type 3s, using a laryngofissure approach. ↗
▶ Ep 1 · 4:15
host_summary For type 4 clefts, a cervical approach is used. ↗
▶ Ep 1 · 4:15
host_summary Type 4 long clefts present anesthetic challenges requiring double lumen tube, single lung ventilation, ECMO or bypass, and often have associated microgastria and multiple congenital anomalies. ↗
▶ Ep 1 · 4:15
host_summary Type 4 long clefts have a very high mortality rate of approximately 50%. ↗
▶ Ep 1 · 7:04
quote None of us has been brave enough to tackle a 4 endoscopically yet. ↗
▶ Ep 1 · 7:04
host_summary The transtracheal technique for type 4 clefts involves forming layers between trachea and esophagus, sewing the esophageal layer with knots in lumen, sewing the tracheal layer with knots in lumen, with optional interposition graft. ↗
▶ Ep 1 · 7:04
host_summary Most type 3 clefts are attempted endoscopically unless there is a reason to go open. ↗
▶ Ep 1 · 8:53
host_summary The novel surgical technique for type 4 long clefts involves transecting the trachea at the lower border of the cricoid, peeling the trachea off the esophagus beyond the cleft while keeping the patient intubated into one bronchus, repairing the esophagus with optional second imbricating layer, placing an interposition graft (typically sternal or tibial periosteum), reconnecting the trachea to the cricoid, and placing a tracheostomy relatively late at two or three weeks. ↗
▶ Ep 1 · 10:16
host_summary For the type 4 long cleft case, the team waited three months until the child was greater than 5 kilograms based on outcomes data from previous research. ↗
▶ Ep 1 · 10:16
host_summary When placing an endotracheal tube for type 4 long cleft repair, think big, like 4.5 size. ↗
▶ Ep 1 · 10:16
host_summary The biggest risk with laryngotracheal esophageal clefts is that the distal end turns into a tracheoesophageal fistula. ↗
▶ Ep 1 · 10:16
host_summary Residual tracheoesophageal fistula can be repaired endoscopically using bugbee cautery to demucosalize the tract followed by endoscopic suture placement with P2 needle on 4-0 PDS to create raw-against-raw closure. ↗
Tracheoesophageal Fistula 59 entries

Aerodigestive & Esophageal Surgery - Difficult Tracheal Esophageal Fistula

▶ Ep 4 · 4:39
clinical Most children who aspirate have a functional or neurological problem (cerebral palsy, CHARGE syndrome); some have anatomical problems (TEF, laryngeal cleft, pharyngeal scar, esophageal stenosis). ↗
▶ Ep 4 · 12:10
clinical A 3-French bugbee cautery is a smooth, excellent probe for identifying subtle tracheoesophageal fistulas. ↗
▶ Ep 4 · 13:21
clinical A 70-degree endoscope is a difficult tool to use but can visualize TEFs that are otherwise hard to see with standard forward-viewing scopes. ↗
▶ Ep 4 · 14:51
clinical Pediatric surgery fellows at Cincinnati Children's complete a one-month attachment with ENT to perform bronchoscopies and gain airway expertise. ↗
▶ Ep 4 · 23:41
clinical Endoscopic TEF closure requires demucosalization of the tract (mucosa is a non-stick surface); the goal is raw-against-raw apposition with minimal fibrin glue (0.1 mL) to seal the tract while scarring occurs. ↗
▶ Ep 4 · 30:20
quote You don't want to give the mucosa a fright, you want to destroy it. ↗
▶ Ep 4 · 34:20
clinical Positive-pressure air insufflation (30 cm H₂O) via an endotracheal tube in the esophagus can reveal a TEF by causing air to bubble out of the tracheal opening. ↗
▶ Ep 4 · 37:01
clinical Endoscopic TEF repair success rate is approximately 80%, typically requiring 2 attempts; after 3–4 failed attempts, open repair should be considered. ↗
▶ Ep 4 · 38:35
clinical When cauterizing in the airway with a bugbee, oxygen concentration should be kept below 30% to minimize fire risk; brief periods of lower oxygen saturation are tolerable. ↗
▶ Ep 4 · 39:48
clinical Injection of an inert material (e.g., Radiesse voice gel) into the walls adjacent to a TEF tract can obliterate the potential space and promote raw-on-raw apposition; the material is absorbed over a few weeks. ↗
▶ Ep 4 · 45:48
clinical Slide tracheoplasty for TEF involves transecting the trachea above and below the fistula, beveling the edges, turning in the tracheal wings to repair the esophagus, interposing sternal periosteum, and reconnecting the trachea; it is a three-layer repair. ↗
▶ Ep 4 · 46:52
clinical Sternal periosteum is an excellent interposition graft material: it is abundant, in the surgical field, and extremely strong ('like Kevlar'), though difficult to suture. ↗
▶ Ep 4 · 53:37
guideline Button batteries can cause ongoing tissue injury for weeks after ingestion, even if 'dead' (they retain ~2 volts); institutional protocol mandates removal within 2 hours of identification. ↗
▶ Ep 4 · 54:02
clinical Two slide tracheoplasty repairs for button battery TEF both dehisced (one at 10 days, one at 3 months); both were successfully revised. This may be more than coincidence, suggesting button battery injuries pose unique challenges. ↗
▶ Ep 4 · 1:04:43
clinical Transtracheal repair technique: anterior tracheotomy, identify the fistula from within the trachea, separate tracheal and esophageal layers, three-layer closure (esophageal mucosa with knots in lumen, sternal periosteum, tracheal wall with knots in lumen). ↗
▶ Ep 4 · 1:09:04
opinion Transtracheal TEF repair is a two-dimensional operation with lower complication risk than slide tracheoplasty; the primary complication is re-fistulization, whereas slide tracheoplasty dehiscence is a more serious event. ↗
▶ Ep 4 · 1:09:59
opinion Slide tracheoplasty appears to be a learning-curve, surgeon-dependent operation; revision cases have been necessary as experience was gained. ↗
▶ Ep 4 · 1:17:21
clinical When repairing a high TEF from a thoracic approach, ligation of the fistula on the esophageal side can leave a large tracheal pouch; if the patient has tracheomalacia and requires a tracheostomy, the tube may enter the pouch, causing life-threatening obstruction. ↗
▶ Ep 4 · 1:23:36
quote You can actually lubricate the needle with a copious amount of swear words. I found that really helpful. ↗
▶ Ep 4 · 1:24:32
quote If it barks like a dog and it wags its tail, it's probably a dog. ↗
▶ Ep 4 · 1:34:43
clinical In patients with retroesophageal subclavian artery, the right recurrent laryngeal nerve is non-recurrent and at higher risk during neck dissection; awareness is critical during transtracheal or slide tracheoplasty approaches. ↗
▶ Ep 4 · 1:35:23
clinical After 7 years of aspiration through a TEF, a child may have significant bronchiectasis; repair of the fistula does not immediately resolve lower airway disease, and ongoing chest physiotherapy and airway clearance are required. ↗
▶ Ep 4 · 1:37:35
clinical Hearing aid molds are radiolucent and can be missed on chest X-ray; high clinical suspicion is required when a foreign body ingestion is reported but not visualized. ↗
▶ Ep 4 · 1:39:49
clinical Pectus excavatum can worsen tracheobronchomalacia; placement of a pectus bar can improve airway support and reduce the need for stenting or tracheostomy. ↗
▶ Ep 4 · 1:40:32
clinical Airway stents can erode into the esophagus, creating secondary fistulas; long-term stent management requires vigilance and may necessitate alternative strategies (e.g., Y-stent with tracheostomy tube within the stent). ↗
▶ Ep 4 · 1:40:56
clinical A Y-shaped airway stent from both bronchi into the trachea, with the tracheostomy tube sitting within the stent, can effectively bypass a bronchoesophageal fistula and allow clinical stability when further repair is not feasible. ↗
▶ Ep 4 · 1:41:24
quote Sometimes the first domino falls, and they just keep falling. ↗
▶ Ep 4 · 1:47:43
clinical Endoscopic closure of bronchoesophageal fistulas is feasible but challenging; proximity to large vessels (e.g., pulmonary artery branches) may preclude safe cautery and necessitate surgical resection. ↗
▶ Ep 4 · 1:52:57
quote I'm having a really bad day. ↗
▶ Ep 4 · 1:58:01
clinical Tracheal pouches (diverticula) can be marsupialized endoscopically using a Storz ClickLine laparoscopic biopsy forceps with cautery at 40 watts; the technique is quick, well-tolerated, and eliminates the risk of tracheostomy tube misplacement. ↗

QUAD #6 Slide Tracheoplasty for TEF, Otolaryngology Approach with Dr. Mike Rutter

▶ Ep 10 · 0:49
clinical Slide tracheoplasty can be used as a method of repairing challenging tracheoesophageal fistulas ↗
▶ Ep 10 · 1:03
quote You've got a very tight ring segment with a fistula behind the ring segment, and you can see how narrow the distal trachea is. ↗
▶ Ep 10 · 1:11
clinical In a case with complete tracheal rings and TEF, both conditions were repaired simultaneously because there was no other option ↗
▶ Ep 10 · 1:11
quote We went on and repaired both at the same time because we really didn't have an option ↗
▶ Ep 10 · 1:25
quote The technique is that we basically transect the trachea above and below the hole with a sort of a bevel, so we're not losing too much trachea. ↗
▶ Ep 10 · 1:25
clinical The slide tracheoplasty technique involves transecting the trachea above and below the hole with a bevel to avoid losing too much trachea ↗
▶ Ep 10 · 1:35
quote Use part of the trachea to repair the esophagus, slide the trachea over the top of it, quite often with a little interposition graft of periosteum. ↗
▶ Ep 10 · 1:35
clinical Part of the trachea is used to repair the esophagus, then the trachea is slid over the top of it, often with a periosteal interposition graft ↗
▶ Ep 10 · 1:54
quote She's had thoracotomies, tracheal resections, flaps, because they couldn't get rid of the hole, they just left a T tube in place and, and she aspirates chronically. ↗
▶ Ep 10 · 2:18
quote And so this is a slight tracheoplasty technique, and you can see the bougie in the esophagus, we've transected the trachea above and below, and we're sewing this flap of trachea onto the esophagus, so the front wall of the esophagus is now gonna be a piece of trachea, just a a quick running suture technique with 4 OPDS. ↗
▶ Ep 10 · 2:18
clinical In the slide tracheoplasty repair, a flap of trachea is sewn onto the esophagus so the front wall of the esophagus becomes a piece of trachea, using a quick running suture technique with 4-0 PDS ↗
▶ Ep 10 · 2:47
clinical When the distance between trachea and esophagus is large, using nerve hooks and slowly tightening multiple throws brings the structures together ↗
▶ Ep 10 · 2:47
quote And so if you use nerve hooks and you just take your time slowly tightening up the multiple throws you've already done, it slowly comes together. ↗
▶ Ep 10 · 3:08
clinical In the Swedish patient case, esophagoscopy at one month post-op showed the suture line where trachea was sewn to esophagus with the front wall being a piece of trachea ↗
▶ Ep 10 · 3:24
clinical The Swedish patient returned to eating and drinking everything despite having a very short trachea ↗
▶ Ep 10 · 3:24
quote She went back to Sweden, she's eating and drinking everything, she's got a really short trachea, and she's doing fine. ↗
▶ Ep 10 · 3:44
quote She was referred to us aspirating on high flow with a chest tube in place. ↗
▶ Ep 10 · 4:05
quote There's suture material everywhere to the point you don't actually know where the lumen is in the esophagus. ↗
▶ Ep 10 · 4:23
quote She's had two thoracotomies, you couldn't mobilize her esophagus, and so we stabilized her initially by putting in an esophageal stent, bought her some time, that didn't fix the holes, but got rid of the mediastinal communication. ↗
▶ Ep 10 · 4:23
clinical In the 4-year-old case, initial stabilization was achieved by placing an esophageal stent, which did not fix the holes but eliminated the mediastinal communication ↗
▶ Ep 10 · 4:50
clinical A transsternal, transtracheal approach provides fantastic exposure to the esophagus ↗
▶ Ep 10 · 4:50
quote You get fantastic exposure to the esophagus. ↗
▶ Ep 10 · 4:55
quote We went transternal, transtracheal, and we took a little bit of tibial periosteum as a nice interposition graft. ↗
▶ Ep 10 · 4:55
clinical Tibial periosteum serves as a good interposition graft ↗
▶ Ep 10 · 5:05
clinical Periosteum is effective at protecting one lumen from another ↗
▶ Ep 10 · 5:05
quote Periosteum is really good at protecting one lumen from another. ↗
▶ Ep 10 · 6:14
quote For challenging tracheoesophageal fistulas, a slight tracheoplasty can be a very valuable addition to the options available for repair. ↗
▶ Ep 10 · 6:26
quote You're not gonna do this for everyone, it's just useful knowing that there are options available. ↗
▶ Ep 10 · 6:26
opinion Slide tracheoplasty is not appropriate for every TEF case, but it is useful to know the option is available ↗