Sidra Medicine conducts complex airway surgery for kids with rare throat conditions

QF Entity highlights continued multidisciplinary focus to advance medical care for children in Qatar

08 June 2020, Doha, Qatar – Surgeons at Sidra Medicine, a member of Qatar Foundation, have performed a laryngotracheal reconstruction surgery on a baby born with a rare throat condition.

Baby Lulwa was born with a laryngeal web and subglottic stenosis. This meant that her upper windpipe (trachea) was very narrow and her larynx (also known as voice box) had a thick layer of web-like tissue covering it, making it difficult for her to breathe normally. The condition is a rare birth defect, with an estimated incidence of 1 per 4000001.

Dr. Faisal Abdulkader, Division Chief of Ear, Nose and Throat (ENT) and Otolaryngology, Sidra Medicine said: “When Lulwa was transferred to Sidra Medicine in late 2019, it was important to get a full picture of her condition so as to plan the right treatment program. Laryngeal web can sometimes be misdiagnosed for asthma, as the symptoms of raspy breathing and shortness of breath are very similar. Without immediate intervention, the openness (patency) of her airway will be at risk.”

During her initial assessments at Sidra Medicine, a laryngoscopy, which is a small flexible telescope, was inserted into Lulwa’s airway to see the extent of the blockage and the thickness of the web-like tissue. Taking Sidra Medicine’s renowned multidisciplinary (MDT) based approach to patient care, Dr. Abdulkader and the MDT team reviewed all the options available - minimally invasive and surgery - in consultation with her parents.

Lulwa’s MDT based care at Sidra Medicine was handled with the combined expertise of otolaryngology; head and neck surgery; pediatric anesthesia; the pediatric intensive care unit (PICU); speech and language therapy and child life services.

Laryngotracheal reconstruction surgery is considered a best practice methodology and is used by some of the leading children’s hospitals around the world. It is a safe and stable procedure and a suitable alternative to clearing blocked windpipes without the need for a tracheostomy.

Lulwa underwent two phases of the reconstruction surgery. During the first phase, the division of her vocal cord web and a balloon dilatation to her trachea was performed. This helped address the narrowing at her vocal cords however, her trachea needed more definitive surgical reconstruction.

The second stage of Lulwa’s reconstruction surgery involved inserting a small piece of cartilage into the narrowed section of her windpipe to make it wider. This final procedure allowed surgeons to open her airway to its full capacity for her breathe freely and clearly. An endotracheal tube was used as a stent to open the airway (known as intubation). She was then transferred to the PICU for a week to keep her intubated.

Dr. Khaled Khalifa Bshesh, Senior Attending PICU Physician, Sidra Medicine said: “Sidra Medicine has established a world-class critical care program to ensure we keep our young patients safe in an environment designed to promote healing. A lot of people don’t realize that intubation in the PICU is more difficult and comes with a certain degree of high risk than in the operating theater. Lulwa was under the watchful eye of our dedicated and trained team of specialists and we were delighted with her full recovery.”

Lulwa’s parents said: “During our daughter’s initial assessments, we sought a second opinion with doctors outside of Qatar to confirm whether we were taking the right approach. We were assured when they validated that Sidra Medicine, with its expert team and technologies, was one of the best children’s hospitals in the Middle East to conduct the surgery. We couldn’t be happier to see our beautiful daughter thrive under the care and attention of the staff. We were equally impressed how we as parents were part of the decision making progress. This helped us become a very important part of our daughter’s recovery.”

In the weeks following surgery, the MDT team performed regular endoscopic exams and a video fluoroscopy to check on Lulwa airway and her ability to swallow. She was also assessed by a speech and language therapist and received an outpatient based care plan to ensure her full recovery.

Dr. Mansour Ali, Chair of Pediatric Surgery at Sidra Medicine said: “I am very proud of the teamwork in Lulwa’s case. Despite the rarity and the complexity of her condition, this was the first time the management of such a case was performed in Qatar without the need for a tracheostomy. It is important to highlight the specialist expertise that we have at Sidra Medicine throughout the entire journey of care for our young patients – from our surgery to pediatric anesthesiology, through PICU and child life services. We want families in Qatar to be assured of our commitment to providing the highest levels of care for their children.”