I am working on an article regarding a case of anterior glottic web and a self made silicone keel ,so wanted data regarding the keels available in the market for comparison.
also if you ll have managed cases of thin anterior glottic webs ,please share your experience if possible. thank you.
Usually they are managed by using laser.Keel may not be required in all the cases.Regarding the keels available in the market - web search can be done
sir we had done web lysis without the keel using laser as it was a thin cohens type 3 web and applied mitomycin. But it recurred hence we went for keel placement endoscopically.
Hi
I generally use laser, I have on one occasion placed a silicone sheet over the web.
To do this insert a large needle through cricothyroid membrane and 5mm above the anterior commisue into the anterior thyroid cartilage.
Now use a long nylon suture, fold the silicon and pass the suture through it. Cut the needle off. Insert the nylon endolaryngeal through the needles. pull the silicon into place over the divided web. Then remove needles and secure with beads to the skin. It should not be too tight, but also not move around on the inside.
Consent the patient to potential airway concerns and leave in for 2 weeks. This allows the laryngeal mucosa to grow under. Results have been OK.
Cheers
Thank you sir. We have operated the patient in a similar manner. This technique is similar to the Dedo's technique.
We used prolene and a self made keel with needles from the blood transfusion set which have a wide bore.
The voice quality postop is not very significantly different but anatomical results are good. No recurrence of Web.
We had made the keel using easily available components. Have described it in the article I have written.
I use silicone sheet inserted endoscopically in the anterior commissure, and fixed externally by sutures
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