# Pediatric Airway Reconstruction & Stenosis Management — GCMD Library living collection

Updated: n/a · 42 episodes · 51 cited statements

## Episodes
### Laryngotracheal Reconstruction
- [Airway and Swallowing Outcomes Following Laryngotracheoplasty With Posterior Grafting in Children](https://library.globalcastmd.com/watch/airway-and-swallowing-outcomes-following-laryngotracheoplasty-with-posterior-gra-15159) — article · [machine version](https://library.globalcastmd.com/watch/airway-and-swallowing-outcomes-following-laryngotracheoplasty-with-posterior-gra-15159.md)
- [Outcome measures for pediatric laryngotracheal reconstruction: International consensus statement](https://library.globalcastmd.com/watch/outcome-measures-for-pediatric-laryngotracheal-reconstruction-international-cons-15176) — article · [machine version](https://library.globalcastmd.com/watch/outcome-measures-for-pediatric-laryngotracheal-reconstruction-international-cons-15176.md)
- [Short- versus Long-term Stenting in Children with Subglottic Stenosis Undergoing Laryngotracheal Reconstruction](https://library.globalcastmd.com/watch/short-versus-long-term-stenting-in-children-with-subglottic-stenosis-undergoing-15180) — article · [machine version](https://library.globalcastmd.com/watch/short-versus-long-term-stenting-in-children-with-subglottic-stenosis-undergoing-15180.md)
- [A multicenter study analyzing the impact of pre-existing comorbidities on laryngotracheal reconstruction (LTR) outcomes.](https://library.globalcastmd.com/watch/a-multicenter-study-analyzing-the-impact-of-pre-existing-comorbidities-on-laryng-15200) — article · [machine version](https://library.globalcastmd.com/watch/a-multicenter-study-analyzing-the-impact-of-pre-existing-comorbidities-on-laryng-15200.md)
- [Outcomes of Prophylactic Epiglottic Petiole Suspension at the Time of Complete Laryngofissure](https://library.globalcastmd.com/watch/outcomes-of-prophylactic-epiglottic-petiole-suspension-at-the-time-of-complete-l-15170) — article · [machine version](https://library.globalcastmd.com/watch/outcomes-of-prophylactic-epiglottic-petiole-suspension-at-the-time-of-complete-l-15170.md)
- [Impedance probe testing prior to pediatric airway reconstruction](https://library.globalcastmd.com/watch/impedance-probe-testing-prior-to-pediatric-airway-reconstruction-15192) — article · [machine version](https://library.globalcastmd.com/watch/impedance-probe-testing-prior-to-pediatric-airway-reconstruction-15192.md)

### Subglottic Stenosis
- [In Reference to Establishing an Endoscopic Chronic Subglottic Stenosis Rabbit Model.](https://library.globalcastmd.com/watch/in-reference-to-establishing-an-endoscopic-chronic-subglottic-stenosis-rabbit-mo-15202) — article · [machine version](https://library.globalcastmd.com/watch/in-reference-to-establishing-an-endoscopic-chronic-subglottic-stenosis-rabbit-mo-15202.md)
- [Establishing an Endoscopic Chronic Subglottic Stenosis Rabbit Model](https://library.globalcastmd.com/watch/establishing-an-endoscopic-chronic-subglottic-stenosis-rabbit-model-15205) — article · [machine version](https://library.globalcastmd.com/watch/establishing-an-endoscopic-chronic-subglottic-stenosis-rabbit-model-15205.md)

### Tracheal Anomalies
- [Characteristics and Outcomes of Surgical Treatment for Bronchial Anomalies.](https://library.globalcastmd.com/watch/characteristics-and-outcomes-of-surgical-treatment-for-bronchial-anomalies-15153) — article · [machine version](https://library.globalcastmd.com/watch/characteristics-and-outcomes-of-surgical-treatment-for-bronchial-anomalies-15153.md)
- [Congenital Absence of Tracheal or Bronchial Rings.](https://library.globalcastmd.com/watch/congenital-absence-of-tracheal-or-bronchial-rings-15164) — article · [machine version](https://library.globalcastmd.com/watch/congenital-absence-of-tracheal-or-bronchial-rings-15164.md)
- [Growth and Management of Repaired Complete Tracheal Rings after Slide Tracheoplasty.](https://library.globalcastmd.com/watch/growth-and-management-of-repaired-complete-tracheal-rings-after-slide-tracheopla-15173) — article · [machine version](https://library.globalcastmd.com/watch/growth-and-management-of-repaired-complete-tracheal-rings-after-slide-tracheopla-15173.md)
- [Unrepaired Complete Tracheal Rings: Natural History and Management Considerations](https://library.globalcastmd.com/watch/unrepaired-complete-tracheal-rings-natural-history-and-management-considerations-15179) — article · [machine version](https://library.globalcastmd.com/watch/unrepaired-complete-tracheal-rings-natural-history-and-management-considerations-15179.md)
- [Slide tracheoplasty for the treatment of tracheoesophogeal fistulas](https://library.globalcastmd.com/watch/slide-tracheoplasty-for-the-treatment-of-tracheoesophogeal-fistulas-15191) — article · [machine version](https://library.globalcastmd.com/watch/slide-tracheoplasty-for-the-treatment-of-tracheoesophogeal-fistulas-15191.md)
- [Cervical slide tracheoplasty](https://library.globalcastmd.com/watch/cervical-slide-tracheoplasty-15195) — article · [machine version](https://library.globalcastmd.com/watch/cervical-slide-tracheoplasty-15195.md)
- [Long-term outcomes of children undergoing slide tracheoplasty: An institutional review of 227 patients](https://library.globalcastmd.com/watch/long-term-outcomes-of-children-undergoing-slide-tracheoplasty-an-institutional-r-15197) — article · [machine version](https://library.globalcastmd.com/watch/long-term-outcomes-of-children-undergoing-slide-tracheoplasty-an-institutional-r-15197.md)
- [Slide Tracheoplasty for Repair of Complex Tracheoesophageal Fistulas.](https://library.globalcastmd.com/watch/slide-tracheoplasty-for-repair-of-complex-tracheoesophageal-fistulas-15207) — article · [machine version](https://library.globalcastmd.com/watch/slide-tracheoplasty-for-repair-of-complex-tracheoesophageal-fistulas-15207.md)
- [Combined cervical and thoracic approach for esophageal atresia with tracheopexy](https://library.globalcastmd.com/watch/combined-cervical-and-thoracic-approach-for-esophageal-atresia-with-tracheopexy-15139) — podcast · 5:26 · [machine version](https://library.globalcastmd.com/watch/combined-cervical-and-thoracic-approach-for-esophageal-atresia-with-tracheopexy-15139.md)
- [QUAD #1: Cervical Tracheopexy with Dr. Alessandro de Alarcon](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779) — video · 5:26 · [machine version](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779.md)
- [International Pediatric Otolaryngology Group (IPOG) consensus recommendations: Evaluation and management of congenital tracheal stenosis](https://library.globalcastmd.com/watch/international-pediatric-otolaryngology-group-consensus-recommendations-evaluatio-15154) — article · [machine version](https://library.globalcastmd.com/watch/international-pediatric-otolaryngology-group-consensus-recommendations-evaluatio-15154.md)

### Tracheomalacia
- [Differences in Flexible and Rigid Bronchoscopy for Assessment of Tracheomalacia](https://library.globalcastmd.com/watch/differences-in-flexible-and-rigid-bronchoscopy-for-assessment-of-tracheomalacia-15214) — article · [machine version](https://library.globalcastmd.com/watch/differences-in-flexible-and-rigid-bronchoscopy-for-assessment-of-tracheomalacia-15214.md)
- [Ultrashort Echo-Time MRI for the Assessment of Tracheomalacia in Neonates](https://library.globalcastmd.com/watch/ultrashort-echo-time-mri-for-the-assessment-of-tracheomalacia-in-neonates-15218) — article · [machine version](https://library.globalcastmd.com/watch/ultrashort-echo-time-mri-for-the-assessment-of-tracheomalacia-in-neonates-15218.md)

### A-Frame Deformity
- [Management of A-Frame Tracheal Deformity in Children With Endoscopic Resection Tracheoplasty.](https://library.globalcastmd.com/watch/management-of-a-frame-tracheal-deformity-in-children-with-endoscopic-resection-t-15211) — article · [machine version](https://library.globalcastmd.com/watch/management-of-a-frame-tracheal-deformity-in-children-with-endoscopic-resection-t-15211.md)
- [Tracheal A-Frame Deformities Following Airway Reconstruction](https://library.globalcastmd.com/watch/tracheal-a-frame-deformities-following-airway-reconstruction-15213) — article · [machine version](https://library.globalcastmd.com/watch/tracheal-a-frame-deformities-following-airway-reconstruction-15213.md)

### Imaging & Diagnostics
- [Pilot Study to Assess the Use of Ultrasound in Evaluating the Abnormal Pediatric Airway](https://library.globalcastmd.com/watch/pilot-study-to-assess-the-use-of-ultrasound-in-evaluating-the-abnormal-pediatric-15167) — article · [machine version](https://library.globalcastmd.com/watch/pilot-study-to-assess-the-use-of-ultrasound-in-evaluating-the-abnormal-pediatric-15167.md)

### More resources
- [Cervical slide tracheoplasty in adults with laryngotracheal stenosis](https://library.globalcastmd.com/watch/cervical-slide-tracheoplasty-in-adults-with-laryngotracheal-stenosis-15219) — article · [machine version](https://library.globalcastmd.com/watch/cervical-slide-tracheoplasty-in-adults-with-laryngotracheal-stenosis-15219.md)
- [Revision thoracic slide tracheoplasty: Outcomes following unsuccessful tracheal reconstruction.](https://library.globalcastmd.com/watch/revision-thoracic-slide-tracheoplasty-outcomes-following-unsuccessful-tracheal-r-15220) — article · [machine version](https://library.globalcastmd.com/watch/revision-thoracic-slide-tracheoplasty-outcomes-following-unsuccessful-tracheal-r-15220.md)
- [Facial Palsy Following Embolization of a Juvenile Nasopharyngeal Angiofibroma](https://library.globalcastmd.com/watch/facial-palsy-following-embolization-of-a-juvenile-nasopharyngeal-angiofibroma-15221) — article · [machine version](https://library.globalcastmd.com/watch/facial-palsy-following-embolization-of-a-juvenile-nasopharyngeal-angiofibroma-15221.md)
- [Temporal Segmentation for Laryngeal High-Speed Videoendoscopy in Connected Speech](https://library.globalcastmd.com/watch/temporal-segmentation-for-laryngeal-high-speed-videoendoscopy-in-connected-speec-15222) — article · [machine version](https://library.globalcastmd.com/watch/temporal-segmentation-for-laryngeal-high-speed-videoendoscopy-in-connected-speec-15222.md)
- [Interdisciplinary approach to esophageal replacement and major airway reconstruction.](https://library.globalcastmd.com/watch/interdisciplinary-approach-to-esophageal-replacement-and-major-airway-reconstruc-15223) — article · [machine version](https://library.globalcastmd.com/watch/interdisciplinary-approach-to-esophageal-replacement-and-major-airway-reconstruc-15223.md)
- [Experimental Investigation on Minimum Frame Rate Requirements of High-Speed Videoendoscopy for Clinical Voice Assessment](https://library.globalcastmd.com/watch/experimental-investigation-on-minimum-frame-rate-requirements-of-high-speed-vide-15224) — article · [machine version](https://library.globalcastmd.com/watch/experimental-investigation-on-minimum-frame-rate-requirements-of-high-speed-vide-15224.md)
- [The nasogastric tube syndrome in infants](https://library.globalcastmd.com/watch/the-nasogastric-tube-syndrome-in-infants-15225) — article · [machine version](https://library.globalcastmd.com/watch/the-nasogastric-tube-syndrome-in-infants-15225.md)
- [Voice outcomes following adult cricotracheal resection.](https://library.globalcastmd.com/watch/voice-outcomes-following-adult-cricotracheal-resection-15226) — article · [machine version](https://library.globalcastmd.com/watch/voice-outcomes-following-adult-cricotracheal-resection-15226.md)
- [Endoscopic airway management in children](https://library.globalcastmd.com/watch/endoscopic-airway-management-in-children-15227) — article · [machine version](https://library.globalcastmd.com/watch/endoscopic-airway-management-in-children-15227.md)
- [Controversies in aural atresia repair](https://library.globalcastmd.com/watch/controversies-in-aural-atresia-repair-15228) — article · [machine version](https://library.globalcastmd.com/watch/controversies-in-aural-atresia-repair-15228.md)
- [Screening and treatment of MRSA colonization in pediatric airway surgery patients](https://library.globalcastmd.com/watch/screening-and-treatment-of-mrsa-colonization-in-pediatric-airway-surgery-patient-15229) — podcast · 8:21 · [machine version](https://library.globalcastmd.com/watch/screening-and-treatment-of-mrsa-colonization-in-pediatric-airway-surgery-patient-15229.md)
- [Patient and Family Resources](https://library.globalcastmd.com/watch/patient-and-family-resources-15230) — article · [machine version](https://library.globalcastmd.com/watch/patient-and-family-resources-15230.md)
- [Resources for Healthcare Professionals](https://library.globalcastmd.com/watch/resources-for-healthcare-professionals-15231) — article · [machine version](https://library.globalcastmd.com/watch/resources-for-healthcare-professionals-15231.md)
- [Researchers, Cincinnati Children's Hospital Medical Center](https://library.globalcastmd.com/watch/researchers-cincinnati-children-s-hospital-medical-center-15232) — article · [machine version](https://library.globalcastmd.com/watch/researchers-cincinnati-children-s-hospital-medical-center-15232.md)
- [Support Services | Cincinnati Children's Research Foundation](https://library.globalcastmd.com/watch/support-services-cincinnati-children-s-research-foundation-15233) — article · [machine version](https://library.globalcastmd.com/watch/support-services-cincinnati-children-s-research-foundation-15233.md)
- [Research](https://library.globalcastmd.com/watch/research-15234) — article · [machine version](https://library.globalcastmd.com/watch/research-15234.md)
- [Newsroom](https://library.globalcastmd.com/watch/newsroom-15235) — article · [machine version](https://library.globalcastmd.com/watch/newsroom-15235.md)
- [Pdf Non Discrimination Statement.Pdf](https://library.globalcastmd.com/watch/pdf-non-discrimination-statement-pdf-15236) — article · [machine version](https://library.globalcastmd.com/watch/pdf-non-discrimination-statement-pdf-15236.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=0) Introduction and Preoperative Workup (Ep 18)
- [1:14](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=74) Intraoperative Setup and Tools (Ep 18)
- [1:47](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=107) Surgical Technique and Approach (Ep 18)
- [3:24](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=204) Outcomes and Follow-up (Ep 18)
- [4:32](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=272) Summary and Conclusion (Ep 18)
- [0:00](https://library.globalcastmd.com/watch/combined-cervical-and-thoracic-approach-for-esophageal-atresia-with-tracheopexy-15139?t=0) Introduction and Conference Context (Ep 17)
- [1:14](https://library.globalcastmd.com/watch/combined-cervical-and-thoracic-approach-for-esophageal-atresia-with-tracheopexy-15139?t=74) Preoperative Workup and Intraoperative Setup (Ep 17)
- [1:47](https://library.globalcastmd.com/watch/combined-cervical-and-thoracic-approach-for-esophageal-atresia-with-tracheopexy-15139?t=107) Surgical Technique for Cervical Tracheopexy (Ep 17)
- [3:24](https://library.globalcastmd.com/watch/combined-cervical-and-thoracic-approach-for-esophageal-atresia-with-tracheopexy-15139?t=204) Case Example and Outcome Measures (Ep 17)
- [4:43](https://library.globalcastmd.com/watch/combined-cervical-and-thoracic-approach-for-esophageal-atresia-with-tracheopexy-15139?t=283) Summary and Closing (Ep 17)
- [0:00](https://library.globalcastmd.com/watch/screening-and-treatment-of-mrsa-colonization-in-pediatric-airway-surgery-patient-15229?t=0) Introduction and Study Context (Ep 35)
- [0:35](https://library.globalcastmd.com/watch/screening-and-treatment-of-mrsa-colonization-in-pediatric-airway-surgery-patient-15229?t=35) MRSA Colonization Definition and Protocol Development (Ep 35)
- [2:39](https://library.globalcastmd.com/watch/screening-and-treatment-of-mrsa-colonization-in-pediatric-airway-surgery-patient-15229?t=159) Clinical Importance and Impact of MRSA Infections (Ep 35)
- [4:17](https://library.globalcastmd.com/watch/screening-and-treatment-of-mrsa-colonization-in-pediatric-airway-surgery-patient-15229?t=257) Cincinnati Children's MRSA Work and High-Risk Population (Ep 35)
- [6:48](https://library.globalcastmd.com/watch/screening-and-treatment-of-mrsa-colonization-in-pediatric-airway-surgery-patient-15229?t=408) Study Conclusions and Clinical Recommendations (Ep 35)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Cincinnati Children's typically uses a combined cervical and thoracic approach for esophageal atresia cases. — Alessandro de Alarcon (clinical) [Ep 18 · 0:49](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=49)
- Required intraoperative equipment includes a neck tray, MLB tray, and Maloney dilators or NG tubes. — Alessandro de Alarcon (clinical) [Ep 18 · 1:15](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=75)
- Flexible bronchoscopy during the operation is key, and endotracheal tube placement must allow visualization during the procedure. — Alessandro de Alarcon (clinical) [Ep 18 · 1:21](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=81)
- Nasotracheal intubation is often used with the cuff positioned high, sometimes almost at the glottis. — Alessandro de Alarcon (clinical) [Ep 18 · 1:29](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=89)
- A NIM tube is preferred when possible to prevent injury to recurrent nerves or provide awareness when approaching them. — Alessandro de Alarcon (clinical) [Ep 18 · 1:39](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=99)
- The surgical approach uses subplatysmal flaps and addresses anterior compression as needed. — Alessandro de Alarcon (clinical) [Ep 18 · 1:55](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=115)
- Aortopexy and innominate artery pexy can be added at the same time as the cervical procedure. — Alessandro de Alarcon (clinical) [Ep 18 · 2:09](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=129)
- The Cincinnati team has learned not to be afraid of mobilizing the esophagus, which is important for the procedure. — Alessandro de Alarcon (opinion) [Ep 18 · 2:29](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=149)
- Stitches are sometimes placed in the trachea to pull it up and out of the way for visualization of the posterior aspect and spine. — Alessandro de Alarcon (clinical) [Ep 18 · 2:54](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=174)
- The team uses 3-0 prolene sutures and places all stitches before securing them down. — Alessandro de Alarcon (clinical) [Ep 18 · 3:15](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=195)
- Suture placement is performed under spontaneous ventilation conditions. — Alessandro de Alarcon (clinical) [Ep 18 · 3:15](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=195)
- A patient who had prior thoracoscopic tracheopexy with dysphagia from torqued esophagus underwent the combined approach and became symptom-free. — Alessandro de Alarcon (clinical) [Ep 18 · 3:33](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=213)
- Outcome measures include follow-up endoscopy, pulmonary function tests when patients are old enough, and imaging. — Alessandro de Alarcon (clinical) [Ep 18 · 4:00](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=240)
- At 36 months follow-up, imaging may still show tracheomalacia, but patients can be symptomatically better. — Alessandro de Alarcon (clinical) [Ep 18 · 4:09](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=249)
- The team is still learning what measures should define good versus bad outcomes. — Alessandro de Alarcon (opinion) [Ep 18 · 4:15](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=255)
- Managing complications including swallowing dysfunction and vocal fold paralysis is part of postoperative care. — Alessandro de Alarcon (clinical) [Ep 18 · 4:26](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=266)
- Cincinnati Children's typically uses a combined cervical and thoracic approach for esophageal atresia cases. — Alessandro de Alarcon (clinical) [Ep 17 · 0:49](https://library.globalcastmd.com/watch/combined-cervical-and-thoracic-approach-for-esophageal-atresia-with-tracheopexy-15139?t=49)
- Required intraoperative equipment includes a neck tray, MLB tray, and Maloney dilators versus NG tubes. — Alessandro de Alarcon (clinical) [Ep 17 · 1:15](https://library.globalcastmd.com/watch/combined-cervical-and-thoracic-approach-for-esophageal-atresia-with-tracheopexy-15139?t=75)
- Flexible bronchoscopy during the operation is key, with the endotracheal tube placed exactly where needed for visualization. — Alessandro de Alarcon (clinical) [Ep 17 · 1:21](https://library.globalcastmd.com/watch/combined-cervical-and-thoracic-approach-for-esophageal-atresia-with-tracheopexy-15139?t=81)
- Nasotracheal intubation is often used with the cuff positioned very high, sometimes almost at the glottis. — Alessandro de Alarcon (clinical) [Ep 17 · 1:29](https://library.globalcastmd.com/watch/combined-cervical-and-thoracic-approach-for-esophageal-atresia-with-tracheopexy-15139?t=89)
- A NIM tube is used when possible to prevent potential injury to recurrent nerves or provide awareness when getting close to them. — Alessandro de Alarcon (clinical) [Ep 17 · 1:39](https://library.globalcastmd.com/watch/combined-cervical-and-thoracic-approach-for-esophageal-atresia-with-tracheopexy-15139?t=99)
- The standard neck approach involves raising subplatysmal flaps and dealing with anterior compression as needed. — Alessandro de Alarcon (clinical) [Ep 17 · 1:55](https://library.globalcastmd.com/watch/combined-cervical-and-thoracic-approach-for-esophageal-atresia-with-tracheopexy-15139?t=115)
- Aortopexy and mopexy can be added at the same time as the cervical approach. — Alessandro de Alarcon (clinical) [Ep 17 · 2:09](https://library.globalcastmd.com/watch/combined-cervical-and-thoracic-approach-for-esophageal-atresia-with-tracheopexy-15139?t=129)
- The straps are separated to expose the airway and find the esophagus. — Alessandro de Alarcon (clinical) [Ep 17 · 2:13](https://library.globalcastmd.com/watch/combined-cervical-and-thoracic-approach-for-esophageal-atresia-with-tracheopexy-15139?t=133)
- The Cincinnati team has learned not to be afraid of the esophagus, being able to find it, move it, and get it out of the way. — Alessandro de Alarcon (opinion) [Ep 17 · 2:29](https://library.globalcastmd.com/watch/combined-cervical-and-thoracic-approach-for-esophageal-atresia-with-tracheopexy-15139?t=149)
- Stitches are sometimes placed in the trachea to pull it up and out of the way to visualize the posterior aspect where the spine is visible. — Alessandro de Alarcon (clinical) [Ep 17 · 2:54](https://library.globalcastmd.com/watch/combined-cervical-and-thoracic-approach-for-esophageal-atresia-with-tracheopexy-15139?t=174)
- 3-0 Prolene sutures are used, with all stitches placed before securing them down, under spontaneous ventilation conditions. — Alessandro de Alarcon (clinical) [Ep 17 · 3:15](https://library.globalcastmd.com/watch/combined-cervical-and-thoracic-approach-for-esophageal-atresia-with-tracheopexy-15139?t=195)
- A patient who had prior thoracoscopic tracheopexy developed dysphagia from a torqued esophagus, was treated with the combined approach, achieved a good airway, and is now symptom-free. — Alessandro de Alarcon (clinical) [Ep 17 · 3:33](https://library.globalcastmd.com/watch/combined-cervical-and-thoracic-approach-for-esophageal-atresia-with-tracheopexy-15139?t=213)
- Outcome measures include follow-up endoscopy, pulmonary function tests when patients are old enough to perform them, and imaging. — Alessandro de Alarcon (clinical) [Ep 17 · 4:00](https://library.globalcastmd.com/watch/combined-cervical-and-thoracic-approach-for-esophageal-atresia-with-tracheopexy-15139?t=240)
- At 36 months follow-up, imaging may still show some malacia, but patients are symptomatically better. — Alessandro de Alarcon (clinical) [Ep 17 · 4:09](https://library.globalcastmd.com/watch/combined-cervical-and-thoracic-approach-for-esophageal-atresia-with-tracheopexy-15139?t=249)
- The team is still learning what measures should be used to define good versus bad outcomes. — Alessandro de Alarcon (opinion) [Ep 17 · 4:15](https://library.globalcastmd.com/watch/combined-cervical-and-thoracic-approach-for-esophageal-atresia-with-tracheopexy-15139?t=255)
- Managing complications including swallowing dysfunction and vocal fold paralysis is part of the care process. — Alessandro de Alarcon (clinical) [Ep 17 · 4:26](https://library.globalcastmd.com/watch/combined-cervical-and-thoracic-approach-for-esophageal-atresia-with-tracheopexy-15139?t=266)
- MRSA (methicillin-resistant Staph aureus) can cause serious infections in the skin and wound sites after surgery. — Alessandro de Alarcon (clinical) [Ep 35 · 0:35](https://library.globalcastmd.com/watch/screening-and-treatment-of-mrsa-colonization-in-pediatric-airway-surgery-patient-15229?t=35)
- Studies in the last decade show an increasing number of MRSA infections both in the community and during surgical procedures globally. — Alessandro de Alarcon (epidemiological) [Ep 35 · 0:58](https://library.globalcastmd.com/watch/screening-and-treatment-of-mrsa-colonization-in-pediatric-airway-surgery-patient-15229?t=58)
- The increase in resistant bacterial strains is thought to be due to more frequent antibiotic use than in the past. — Alessandro de Alarcon (opinion) [Ep 35 · 1:14](https://library.globalcastmd.com/watch/screening-and-treatment-of-mrsa-colonization-in-pediatric-airway-surgery-patient-15229?t=74)
- At Cincinnati Children's, several patients had severe MRSA infections that led to failure of their airway reconstruction. — Alessandro de Alarcon (clinical) [Ep 35 · 1:27](https://library.globalcastmd.com/watch/screening-and-treatment-of-mrsa-colonization-in-pediatric-airway-surgery-patient-15229?t=87)
- Cincinnati Children's protocol screens patients for MRSA prior to airway surgery and treats colonized patients before and during surgery with appropriate antibiotics. — Alessandro de Alarcon (clinical) [Ep 35 · 1:46](https://library.globalcastmd.com/watch/screening-and-treatment-of-mrsa-colonization-in-pediatric-airway-surgery-patient-15229?t=106)
- MRSA surgical site infections can increase the cost of admission by up to approximately $62,000. — Alessandro de Alarcon (epidemiological) [Ep 35 · 3:00](https://library.globalcastmd.com/watch/screening-and-treatment-of-mrsa-colonization-in-pediatric-airway-surgery-patient-15229?t=180)
- MRSA infections can cause rib grafts used in airway reconstructions to die, leading to complete surgical failure. — Alessandro de Alarcon (clinical) [Ep 35 · 3:19](https://library.globalcastmd.com/watch/screening-and-treatment-of-mrsa-colonization-in-pediatric-airway-surgery-patient-15229?t=199)
- A typical airway reconstruction runs around $90,000 in hospital charges. — Alessandro de Alarcon (epidemiological) [Ep 35 · 3:34](https://library.globalcastmd.com/watch/screening-and-treatment-of-mrsa-colonization-in-pediatric-airway-surgery-patient-15229?t=214)
- Hospital stays for airway reconstruction range from a couple of weeks to about a month. — Alessandro de Alarcon (clinical) [Ep 35 · 3:58](https://library.globalcastmd.com/watch/screening-and-treatment-of-mrsa-colonization-in-pediatric-airway-surgery-patient-15229?t=238)
- Surgical site infections have historically been looked at as accidents or something not preventable. — Alessandro de Alarcon (opinion) [Ep 35 · 4:31](https://library.globalcastmd.com/watch/screening-and-treatment-of-mrsa-colonization-in-pediatric-airway-surgery-patient-15229?t=271)
- Cincinnati Children's is working on protocols to reduce or eliminate surgical site infections by identifying preventable harm. — Alessandro de Alarcon (clinical) [Ep 35 · 4:31](https://library.globalcastmd.com/watch/screening-and-treatment-of-mrsa-colonization-in-pediatric-airway-surgery-patient-15229?t=271)
- About one-third of children with tracheostomies screened at Cincinnati Children's are colonized with MRSA. — Alessandro de Alarcon (epidemiological) [Ep 35 · 5:19](https://library.globalcastmd.com/watch/screening-and-treatment-of-mrsa-colonization-in-pediatric-airway-surgery-patient-15229?t=319)
- Other surgical practices typically define high-risk patient populations as having 8 to 10% MRSA colonization rates. — Alessandro de Alarcon (epidemiological) [Ep 35 · 5:19](https://library.globalcastmd.com/watch/screening-and-treatment-of-mrsa-colonization-in-pediatric-airway-surgery-patient-15229?t=319)
- Robin Cotton is one of the forefathers of airway reconstruction in children. — Alessandro de Alarcon (clinical) [Ep 35 · 5:59](https://library.globalcastmd.com/watch/screening-and-treatment-of-mrsa-colonization-in-pediatric-airway-surgery-patient-15229?t=359)
- Cincinnati Children's airway surgery program focuses on improving outcomes beyond tracheostomy removal, including voice outcomes and long-term quality of life. — Alessandro de Alarcon (clinical) [Ep 35 · 5:59](https://library.globalcastmd.com/watch/screening-and-treatment-of-mrsa-colonization-in-pediatric-airway-surgery-patient-15229?t=359)
- Many children with tracheostomies will be MRSA positive from the tracheostomy site or an additional site. — Alessandro de Alarcon (clinical) [Ep 35 · 6:48](https://library.globalcastmd.com/watch/screening-and-treatment-of-mrsa-colonization-in-pediatric-airway-surgery-patient-15229?t=408)
- The study design could not prove that Cincinnati Children's protocol is the perfect protocol. — Alessandro de Alarcon (opinion) [Ep 35 · 7:07](https://library.globalcastmd.com/watch/screening-and-treatment-of-mrsa-colonization-in-pediatric-airway-surgery-patient-15229?t=427)
- The study showed no increase in MRSA infections in patients who were MRSA positive and treated according to the protocol. — Alessandro de Alarcon (clinical) [Ep 35 · 7:24](https://library.globalcastmd.com/watch/screening-and-treatment-of-mrsa-colonization-in-pediatric-airway-surgery-patient-15229?t=444)
- Centers performing significant airway reconstruction should have a clinical protocol for MRSA screening before surgery and treatment. — Alessandro de Alarcon (guideline) [Ep 35 · 7:24](https://library.globalcastmd.com/watch/screening-and-treatment-of-mrsa-colonization-in-pediatric-airway-surgery-patient-15229?t=444)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Preoperative testing includes dynamic CT imaging, pulmonary function tests, microlaryngoscopy and bronchoscopy, and flexible bronchoscopy. — Todd Ponsky summarizes what Dr. Alessandro de Alarcon said [Ep 18 · 0:55](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=55)
- The cervical approach can assist thoracoscopic procedures by removing residual or regrown large thymus tissue. — Todd Ponsky summarizes what Dr. Alessandro de Alarcon said [Ep 18 · 2:01](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=121)
- In the lateral approach, the surgical team works on the side of the airway to find the esophagus. — Todd Ponsky summarizes what Dr. Alessandro de Alarcon said [Ep 18 · 2:19](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=139)
- Pediatric surgeons identify the recurrent nerve for the ENT team to help prevent injury. — Todd Ponsky summarizes what Dr. Alessandro de Alarcon said [Ep 18 · 2:23](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=143)
- The esophagus is mobilized above the level where the team aims to perform the pexy, making suture placement easier. — Todd Ponsky summarizes what Dr. Alessandro de Alarcon said [Ep 18 · 2:43](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=163)
- A pulmonologist assists with flexible endoscopy through the endotracheal tube to visualize inside the trachea while stitches are placed. — Todd Ponsky summarizes what Dr. Alessandro de Alarcon said [Ep 18 · 3:02](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=182)
- The combined approach is valuable for complicated cases or patients needing additional operations for symptom relief. — Todd Ponsky summarizes what Dr. Alessandro de Alarcon said [Ep 18 · 3:24](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=204)
- Otolaryngology involvement is important both during the procedure and in follow-up due to potential complications. — Todd Ponsky summarizes what Dr. Alessandro de Alarcon said [Ep 18 · 4:32](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=272)
- Preoperative testing includes dynamic CT imaging, pulmonary function tests, microlaryngoscopy and bronchoscopy, and flexible bronchoscopy. — Todd Ponsky summarizes what Dr. Alessandro de Alarcon said [Ep 17 · 1:00](https://library.globalcastmd.com/watch/combined-cervical-and-thoracic-approach-for-esophageal-atresia-with-tracheopexy-15139?t=60)
- Residual or regrown large thymus can be removed during the cervical approach as it is in the way of the thoracoscopic approach. — Todd Ponsky summarizes what Dr. Alessandro de Alarcon said [Ep 17 · 2:01](https://library.globalcastmd.com/watch/combined-cervical-and-thoracic-approach-for-esophageal-atresia-with-tracheopexy-15139?t=121)
- In the lateral approach, the pediatric surgeon stands on the side of the airway to look for the esophagus while the ENT surgeon looks for the recurrent laryngeal nerve. — Todd Ponsky summarizes what Dr. Alessandro de Alarcon said [Ep 17 · 2:19](https://library.globalcastmd.com/watch/combined-cervical-and-thoracic-approach-for-esophageal-atresia-with-tracheopexy-15139?t=139)
- The esophagus is mobilized above the level where the surgeons aim to pexy, making it easier to place sutures exactly where needed. — Todd Ponsky summarizes what Dr. Alessandro de Alarcon said [Ep 17 · 2:43](https://library.globalcastmd.com/watch/combined-cervical-and-thoracic-approach-for-esophageal-atresia-with-tracheopexy-15139?t=163)
- A pulmonologist assists with flexible tracheal endoscopy through the endotracheal tube while stitches are being placed. — Todd Ponsky summarizes what Dr. Alessandro de Alarcon said [Ep 17 · 3:02](https://library.globalcastmd.com/watch/combined-cervical-and-thoracic-approach-for-esophageal-atresia-with-tracheopexy-15139?t=182)
- The combined approach is valuable for complicated cases or patients needing additional operations for symptom relief. — Todd Ponsky summarizes what Dr. Alessandro de Alarcon said [Ep 17 · 3:24](https://library.globalcastmd.com/watch/combined-cervical-and-thoracic-approach-for-esophageal-atresia-with-tracheopexy-15139?t=204)
- Otolaryngology involvement is important both in the procedure and during follow-up, and is easier when already built into the team. — Todd Ponsky summarizes what Dr. Alessandro de Alarcon said [Ep 17 · 4:32](https://library.globalcastmd.com/watch/combined-cervical-and-thoracic-approach-for-esophageal-atresia-with-tracheopexy-15139?t=272)

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