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Pediatric Choanal Atresia

last modified on: Tue, 01/09/2024 - 14:36

GENERAL CONSIDERATIONS​

  1. The indications

PREOPERATIVE PREPARATIONS

  1. Other Considerations

NURSING CONSIDERATIONS

  1. Room Setup
    1. Turn patient 90 degrees
    2. Endoscopic Tower equipment
  2. Instrumentation and Equipment
    1. Microdebrider 4 mm Tricut blade, 2.9 cm straight serated and 3.2 mm high speed round burr
    2. Telescope zero degree 2.7 x18
    3. Telescope 120 degree with uvula retractor
    4. Protects the nasal mucosa)
    5. Pediatric sized ureteral sounds: size 18-22
    6. 16 french chest tubes for newborn
    7. 8 french flexible suction catheter
    8. French eye needle
    9. Dingman retractor
    10. CO2 Laser settings: 5 watts continuous superpulse
    11. myringotomy tray with ear speculums of all sizes
    12. silk suture for soft palate
    13. ruler
  3. Medications (specific to nursing)
    1.  Mitomycin C 10mg/1 ml, total 3 ml
    2. Oxymetazoline
    3. lubricating jelly
  4. Prep and Drape
    1.   Laser precautions
      1.  eye patch
      2. wet towels
      3. laser safe tape
  5. Drains and Dressings
  6. Special Considerations

ANESTHESIA CONSIDERATIONS 

  1.  decreased oxygen tension while using the laser

OPERATIVE PROCEDURE

  1. After informed consent was obtained from the patient's family, the patient was brought to main OR 1 and laid supine on the operating room table. The oropharyngeal tube was removed from the mouth and inhalational anesthetic was induced. She was intubated without difficulty using appropriately-sized OR endotracheal tube. This was taped into position. The patient was rotated 90 degrees. A timeout was performed. The Dingman retractor was placed in the mouth and a silk suture was used to retract the soft palate at the uvularis muscle. An ear speculum was used to obtain a view of the nasal passage. The inferior turbinate was lateralized to improve the unobstructed view of stenosis. The laser was used to obtain access to the nasopharynx in a circumferential manner with care to stay low and close to the septum. After this was performed, attention was turned to the opposite nasal passage in which a similarly performed lateralization of the inferior turbinate with laser of the soft tissue was performed. Following which, a 120-degree telescope was used to visualize patency of the nasal passages with passage of Frazier tip suction. The pediatric true cut forceps were used to perform a posterior septectomy medially to widen stenotic bony choanae at the maxillary crest laterally. The microdebrider was used to remove exposed bone, cartilage, and mucosa. After adequate opening of the nasopharynx was felt to be obtained, 10 mg per 1 mL mitomycin was placed onto cotton pledgets and allowed to set in place for 2 minutes prior to the placement of the nasopharyngeal stents. Two 16-French chest tubes were used to fashion nasopharyngeal stents. The flexible suction catheters were passed through the nasal passages bilaterally. They were then sutured to the more narrow end of the chest tubes and threaded through the oral cavity to the nasal passage independently. These were rotated with tapered end laterally in the nasopharynx with the eustachian tube open as well. It was secured in place using proline suture on French eye needles. A suture sling was placed circumferential around the septum and sutured in place on the right nasal columella. The oropharynx and nasopharynx were copiously irrigated. The procedure was concluded and she was transferred to the PICU in stable condition.

POST-OPERATIVE CARE

  1. stent replacement

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