For Laryngomalacia, Microdebrider-Assisted Supraglottoplasty Preferred

The portable EMG device was used to audibly monitor muscle activity during the procedure. Location of the thyroarytenoid muscle was confirmed by increased action potential density during phonation, which is audibly interpreted by the operator. When the position was confirmed, Botox was injected into the muscle.

The 13 patients in the study underwent a total of 113 injections. There were 13 missed injections, for a successful injection rate of 88.5%. One patient was noted to have had four missed injections, all on the same side; excluding this patient, the successful injection rate rose to 90.1%. There were no complications following any of the injections.

The authors enumerate the advantages of using the portable EMG monitor: the portable nature of the device allows the physician to take it from room to room; it is less expensive than oscilloscope EMG devices; and it does not require a neurologist to interpret the results, as the audible increase in recruitment ensures proper location of the thyroarytenoid muscle. As demonstrated in this study, the portable EMG device provides an acceptably low miss rate for Botox injection in treating adductor SD.

(Laryngoscope 2008;118:942-3)

Understanding the Biology and Treatment of Choanal Atresia

Choanal atresia (CA) is a congenital obstruction of the posterior nasal apertures. The incidence of CA is estimated to be about 1 in 5000 to 7000 live births. Unilateral defects are more common than bilateral ones, and the female-to-male ratio is about 2:1. Associated congenital anomalies can be found in up to 50% of CA cases, with CHARGE syndrome (coloboma, heart defects, CA, growth and mental retardation, genital and ear anomalies) being the most commonly described associated condition. Arthur S. Hengerer, MD, and colleagues prepared a study to review the basic science and embryology of CA, with emphasis on Dr. Hengerer’s experience, and to discuss the treatment of CA.

The researchers conducted a retrospective review of pediatric patients treated for CA by Dr. Hengerer over a 12-year period; the review yielded a total of 73 patients. Unilateral atresia was more common than bilateral atresia by a ratio of 1.6:1, but the incidence in males and females was statistically equal. CHARGE syndrome was the most common associated condition found.

Three standard approaches were used for management of CA in these 73 cases: transpalatal, transnasal, and endoscopic; however, the trend for the majority of more recent cases was toward endoscopic treatment. Most cases (91.8%) had a partial or complete bony atresia plate; all these patients required significant resection to obtain an adequate or permanent opening. If the initial surgery failed, the number of follow-up procedures could be extensive and prolonged. However, once the surgical opening of the choana was achieved, it was unusual for it to stenose down in the long term.