Endoscopic Sinus Surgery For a Patient Status Post a CHEP Procedure (Preview)

Case presentation:

One day, I had received a call from the ENT surgical colleague seeking my opinion on a patient being seen in his office for severe sinusitis.

The patient was a 52 y/o male with the history of smoking, severe gastroesophageal reflux disease (GERD), and bilateral vocal cord carcinoma s/p a cricohyoidoepiglottopexy (CHEP) procedure, radiation and chemotherapy in 2003. The patient presented to the surgeon’s office with a three year history of severe sinusitis treated inadequately with a variety of antibiotics, nasal sprays, and steroids. A CT scan revealed bilateral pansinusitis, multiple air fluid levels, septal deviation, and nasal polyps. The patient needed an endoscopic sinus surgery to alleviate his suffering. However, the surgeon informed me that the patient had been denied surgery from three other ENT surgeons because of the CHEP procedure, and that the patient had refused a tracheostomy in the past.

The ENT surgeon would not proceed with booking the patient for surgery without through input from the head and neck anesthesiologist about managing this patient’s airway. A fiberoptic laryngoscopy done in the ENT’s office revealed ...