Microdirect Laryngoscopy and Bronchoscopy (MDLB)

What is microdirect laryngoscopy and bronchoscopy (MDLB)?

MDLB is a very common procedure done to evaluate the airway, from the mouth all the way to where the lungs branch off. It is a quick procedure that looks for causes of a number of aerodigestive concerns, such as noisy breathing, difficulty breathing, recurrent respiratory infections, aspiration (when food or liquid accidentally enters the airway), coughing, or swallowing difficulty.

• At the Aerodigestive and Airway Reconstruction Center at Lucile Packard Children’s Hospital Stanford, MDLB is often done in conjunction with pulmonary (lung) and gastrointestinal (GI) specialists, who may do additional procedures at the same time in order to get a full evaluation of the aerodigestive tract.
• We frequently coordinate with Pediatric Cardiology to do a baseline assessment at the beginning of a heart surgery to get a good understanding of the status of the major airways.
• This procedure is also often done after airway surgery to monitor and optimize healing and outcomes from the surgery.

Do children need anesthesia for MDLB?

Yes. MDLB is done in the operating room, and children have general anesthesia. They usually don’t need a breathing tube during the procedure and can breathe on their own.

What happens during the procedure?

A high-definition endoscopic camera is inserted into the mouth to examine the upper airway, the voice box (larynx), the windpipe (trachea), and where the lungs split off (bronchi).

• We take measurements of the airway along the tract; look for any congenital anomalies, floppiness, or compression around the voice box; evaluate for any lesions or signs of infection; and examine any scarring or narrowing of the airway.
• We evaluate any connections between the trachea and the esophagus.
• We put the findings in context of the child’s symptoms to make a plan for next steps (if any are needed).

What happens after the procedure?

Children usually stay at the hospital for a few hours before going home. Some have a sore throat afterward. Our team then develops a treatment plan, which can range from close monitoring to medications, or sometimes additional procedures or surgeries.

Our patients are often also seen at other programs at Packard Children’s, including the Center for Pediatric Voice and Swallowing Disorders, the Pediatric Vocal Cord Dysfunction Clinic (Paradoxical Vocal Fold Motion Disorder), Pediatric Heart Surgery, and Gastroenterology, Hepatology and Nutrition.