For Laryngomalacia, Microdebrider-Assisted Supraglottoplasty Preferred

The microdebrider is a safe instrument in trained hands; there is no risk of airway fire, thermal damage, or associated burn to the tissues. Dr. Zalzal said that the biggest advantage of microdebrider-assisted supraglottoplasty is shortened surgical time-about 15 minutes shorter than with the CO2 laser. The microdebrider is practically painless, and it glides over any cartilage that is present-it does not cut the cartilage or burn it, like the laser, he said.

The main downside of the microdebrider is that its aggressive use can result in the removal of too much tissue; but in trained hands, this rarely, if ever, happens, Dr. Zalzal said. The microdebrider is well tolerated and is used in other types of laryngeal diseases, such as laryngeal papillomas, Dr. Collins added.

Training

Typically, a surgeon would be trained to use the microdebrider during his or her residency. At Dr. Zalzal’s institution, residents come from three medical schools; the division also has a fellowship training program. Once a resident becomes adept at suspension microlaryngoscopy and microlaryngeal instruments, he or she would then observe several cases done with a microdebrider. Then we would teach them where to cut, avoiding the interarytenoid area. Then they would perform their own cases, Dr. Zalzal explained.

Two types of microdebriders are currently on the market-one made by Medtronic and one by Gyrus. Neither Dr. Zalzal nor Dr. Collins has a commercial interest in these products.

More about Microdebriders

A microdebrider consists of three key components:

• Console;
• Handpiece;
• Blade.

The console is controlled by a foot pedal that determines the speed and direction of the rotating blade. The handpiece controls the blade and integrates suction to rapidly remove the debris. Suctioning tubes connect to the handpiece. The blade (or bit) can be smooth or serrated and comes in a variety of sizes; blades can be rotated in forward, reverse, or oscillating modes at various speeds.

The main risk of microdebriders is the possibility of removal of normal tissue, which can happen if overzealous suction pressure is used. The operator should always maintain adequate visualization of the blade or bur and be aware of using the instrument too aggressively.

Microbrider Applications

Studies have shown that the microdebrider can be an effective tool for diverse types of procedures. Researchers state that it is a convenient and efficient tool, with several advantages and only one identified risk-that is, inadvertent removal of normal tissue.

Obstructing airway lesions can be removed by the microdebrider, with the obvious goal of restoring oxygenation to the patient. These lesions may be seen in patients with lung cancer or in patients with certain benign conditions, such as postintubation tracheal stenosis, relapsing polychondritis, and Wegener’s granulomatosis.