08:28 AM: Laryngotracheal Reconstruction for Wegeners Subglottic Stenosis

Abstract

OBJECTIVE: 1. To understand the risk and possible mechanism of thermal injury to the tongue during suspension laryngoscopy. 2. To detail the nature of thermal injury from laryngoscopy based on an experimental paradigm. METHODS: Following a cluster of cases in 2005 during which tongue injury was noted following laryngoscopy, the cause was sought out. Case specifics such as operative time, light source, and the nature of the procedure were reviewed from medical records. To further detail the nature of thermal injury, a prospective study was undertaken by exposing roomtemperature fresh meat to laryngoscopy. Tissue heating was recorded over time at fixed distances from the light carrier contact spot. Comparisons were made between the new and old light sources. RESULTS: The common element in the injuries was the introduction of a new make of light source in the operating room. In comparing the new to the old light sources, laryngoscopy with the new brand resulted in tissue heating by 20 degrees F before plateauing at 90 minutes. The tissue heating occurred out to 2 cm from the tip of the light carrier, though this only raised the temperature by 8 degrees F at that distance. The previous brand did not raise tissue temperature even after 90 minutes. CONCLUSIONS: Tissue heating may occur from heated light carriers in operative laryngoscopes. Temperatures in the tongue may increase by 20 degrees F during a 90-minute case. Communication and education of all involved personnel should follow equipment change in the operating room.