and rinsing them down withtepid
water (not cold). Depending on the
patient and the stage of their condition an oral examination may reveal
a soft palate that extends well beyond the cranial aspect of the epiglottis. The laryngeal saccules and
tonsils may be everted. And in endstage cases the larynx may be collapsed.
Surgical treatment for stenotic nares
involves excision of a wedge of the
wings of the nares (see figure 1-2)
Hemorrhage can be severe but is
easily controlled once the incised
edges are sutured back together.
The tip of the epiglottis or the middle
of the tonsils can be used as a landmark for resecting an elongated soft
palate. There are several means of
resection described including laser
and harmonic scalpel. I prefer simple
transection with a scalpel blade to
minimize inflammation of the surrounding tissue. Once soft palate
resection is complete the tip of the
epiglottis should just reach the soft
palate. Hemorrhage is controlled
using a simple continuous pattern of
absorbable suture to over-sew the
cut edge (see figure 3).I use a stay
suture in the remaining palate tissue
to improve my visualization and ease
the placement of my suture. If the
laryngeal saccules are everted, they
can be excised using Metzenbaum
scissors. Bleeding from these structures is minimal. Removal of everted
tonsils is controversial and may or
may not be a necessary step. I tend
to remove them if they appear to
protrude significantly into the airway.
Bleeding from this region is also controlled by suturing the cut edges.
Anesthetic recovery can potentially
be the most challenging part of the
procedure. Postoperative care includes as late as possible extubation, oxygen supplementation, analgesia and short-acting steroids.
These patients must be closely monitored for 24 hours. Re-intubation may
be required if respiratory distress is
observed during recovery.
If you have any questions regarding
this surgery please do not hesitate to
call or text Dr. Jehn at 754-229-1187.