Median sternotomy and use of a pedicled sternocleidomastoid muscle flap in the management of recurrent tracheoesophageal fistula.

Recurrent tracheoesophageal fistula may complicate primary repair of congenital tracheoesophageal fistula. Standard treatment involves repair via a right lateral thoracotomy and use of adjacent soft tissues to separate the suture lines of the fistulous openings. The authors describe an alternative approach via a median sternotomy, which improves access, reduces the operating time required to identify the recurrent fistula, and enables the use of a pedicled sternocleidomastoid muscle flap to decrease the risk of refistulization.

Surgical management of drooling.

The presence of drooling is an indication of an upset in the coordinated mechanism of facial, tongue, and palate muscles. This upset is particularly common in children with cerebral palsy. After extensive investigation and the establishment of the relative significance of the drooling and the degree of cerebral palsy, positive treatment with physiotherapy is then commenced. Those patients whose conditions fail to improve adequately with positive physiotherapy can be helped by staging surgery. Surgery treatment is carried out as a planned procedure. The submandibular ducts are transposed. Submucosal dissection and redirection of salivary flow from the submandibular glands excludes the necessity for extirpation of the salivary glands.