OTO Open (Jul 2020)

Simulation of Pediatric Endoscopic Cricoid Reduction and Expansion

  • Austin J. Scholp MS,
  • Matthew R. Hoffman MD, PhD,
  • Alessandro De Alarcon MD, MPH,
  • Mark E. Gerber MD,
  • Jack J. Jiang MD, PhD,
  • James Scott McMurray MD

DOI
https://doi.org/10.1177/2473974X20946268
Journal volume & issue
Vol. 4

Abstract

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Endoscopic cricoid expansion and reduction are newer approaches to the management of pediatric bilateral vocal fold immobility and postlaryngotracheal reconstruction glottic insufficiency, respectively. These procedures offer a less invasive, endoscopic alternative to procedures that typically required open management with a more prolonged recovery. These technically demanding procedures are currently performed only in select centers, and there is no currently described training model for practicing them. We present a modification to a laryngeal dissection station that allows for simulation of endoscopic cricoid reduction and expansion with excised larynges. The model allows trainees to practice endoscopic posterior cricoid exposure, incision of the cricoid cartilage, placement of a simulated costal cartilage graft for expansion, and endoscopic suturing for reduction. Development of simulators for procedures that are infrequently performed have the potential to help trainees reach surgical competency faster and more safely.