How To: Balloon-Assisted Rib Graft Placement in Endoscopic Posterior Cricoid Split Procedure

by Bshair Aldriweesh, MD, and Ahmed Al Ammar, MD •

PGS = posterior glottic stenosis; SGS = subglottic stenosis.

Nasotracheal intubation is performed under endoscopic guidance, and the patient is transferred to the intensive care unit (ICU). One week later, the patient undergoes a second-look procedure with dexamethasone administration over 48 hours prior to the planned extubation day. First, the presence of an air leak around the endotracheal tube is confirmed. Then, the patient is extubated, and the graft position and mucosal healing are evaluated. The patient is then temporarily re-intubated with a smaller-sized endotracheal tube to be extubated in the ICU.

Results

Five patients underwent EPCS/RG with a balloon-assisted rib graft placement in our tertiary referral center. Their ages ranged from 11 to 19 years old. Two patients were diagnosed with comorbidities. One patient had a seizure disorder, and another patient had inflammatory bowel disease with chronic anemia. Four of the five patients were male. The patients’ demographics, diagnoses, and previous surgical histories are shown in Table I. None of the patients had a pre-existing tracheostomy, and the insufflation technique was applied to administer intraoperative ventilation in all patients. One patient developed sedation withdrawal syndrome, which was conservatively managed by gradual reduction of the sedation dosage. No postoperative complications were observed in the remaining patients. The length of hospital stay ranged from 12 to 17 days (mean = 14.60, standard deviation [SD] = 1.82).

View the video of the technique described here.