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Breathe Easy

07/25/2016

Not long after four year-old Sam Kelly was born, he began to have trouble breathing. He was transported to Floating Hospital for Children, where Pediatric Otolaryngologist Andrew Scott, MD determined that the baby boy’s airway had developed a blockage of early scar tissue. Dr. Scott performed an emergency tracheotomy, creating a hole in the front of Sam’s neck that allowed him to breathe safely until Dr. Scott and Sam’s par­ents could determine a long-term medical solution to his problem. 

A Unique and Successful Approach

Dr. Scott recommended monitoring Sam for the next nine months and then performing a procedure called a laryngo­tracheoplasty—an airway reconstruction that would help the baby breathe nor­mally. Dr. Scott wanted Sam’s family to get a second opinion, just to be certain. The doctors at another Boston pediatric hospital recommended the same opera­tion to Sam’s parents, but said they could not perform it before age two. The family felt that waiting could affect Sam’s speech development and decided to go with Dr. Scott’s recommendation. 

Nine months after Sam’s tracheotomy, Dr. Scott removed the tracheotomy tube and performed airway reconstruction surgery, using cartilage from one of Sam’s ribs to expand his airway. The surgical technique would allow Sam’s recon­structed voice box and windpipe to grow with him, reducing the need for follow-up surgeries. After nine days in the hospital, Sam went home breathing comfortably. He had his last follow-up visit with Dr. Scott in February, and now four, he no longer needs monitoring by a specialist. 

“Sam’s operation was a big deal here in Boston,” Dr. Scott says. “He was one of the younger kids that has ever had the procedure here.” Specialists in the area tend to wait until a child is two before performing the operation, even though hospitals in other parts of the country regularly perform it on infants. “Boston can be quite static sometimes when it comes to medical advancements. That’s one of the things that really sets us apart here at the Floating. We are not encum­bered by ‘This is how we’ve always done it’”, says Dr. Scott. 

Setting the Standard of Care

Floating Hospital also stands out because all of its laryngotracheoplasty procedures are performed by two attending physi­cians, Dr. Scott and Mark Vecchiotti, MD. “It’s not the fellows or residents doing the surgery here,” Dr. Scott says. “This is a case where there are two senior physi­cians in one room.” 

Working together, the hospital’s air­way surgeons, pediatricians, respiratory therapists and nursing staff have created a standardized protocol for postoperative care following laryngotrache­oplasty procedures. Thanks to this collaborative approach, Floating Hospital’s success rates rank among the best published in the medical literature. “We’ve had such good outcomes with our protocol that we’ve pub­lished it,” Dr. Scott says. “It’s now online for anyone in the country to see and follow.”

Part of Floating Hospital’s approach involves collaborating with the pediatric intensive care unit, where patients spend many days recuperating from the surgery. “A successful surgical outcome requires excellent postoper­ative care,” Dr. Scott says, explaining that recovering patients must remain perfectly still or risk pulling out the tem­porary breathing tube. “Our critical care physician and nursing colleagues do a wonderful job of it. And if there are any problems, it’s maybe 20 footsteps from the door of my clinic to the ICU.” 

To Rich Kelly, Sam’s father, the whole procedure could not have gone any bet­ter. “We can’t say enough about Dr. Scott and the entire Floating Hospital team,” Rich says. “I would recommend Floating Hospital to any family without a doubt.” 

To reach Dr. Scott or the Pediatric Otolaryngology—Head and Neck Surgery Division at Floating Hospital for Children, please call 866-609-4452.