Contributor: VyVy N. Young and Clark A. Rosen Lipoinjection of the vocal folds results in medialization and augmentation of the vocal folds by deposition of autologous fat. Editor Recruited By: Michael Johns, III, MD DOI: http://dx.doi.org/10.17797/ngjuxe20iq

The C-arm is then placed in a right anterior oblique (RAO) position of about 20-30 degrees. This allows the stomach wall to be visialized as the needle pushes on and then punctures the gastric wall. The appropriate position for the G tube is selected on the skin surface and marked. Three T-fasteners are then prepared for placement. The T-fasteners will be deployed into the lumen of the stomach and then pulled up to keep the stomach against the anterior abdominal wall while the G tube site is dilated and the tube is placed. DOI https://doi.org/10.17797/qrto4chmgs

This video demonstrates a rigid transoral esophagoscopy with endoscopic stapler cricopharyngeus myotomy and diverticulotomy in a patient with Zenker’s Diverticulum.

The procedure in the video demonstrates repair of the bulbar conjunctiva post Mohs Micrographic surgery with an amniotic membrane graft and fibrin glue

Contributor: Tyler McElwee Congenital dacryocystocele describe the distended lacrimal sac in neonates with or without associated intranasal cyst.  The prevalence is about 0.1% of infants with congenital nasolacrimal duct obstruction and a slight prevalence in female infants.  It refers to cystic distention of the lacrimal sac as a consequence of the nasolacrimal drainage system obstruction.  It typically presents as a bluish swelling inferomedial to the medial canthus in the neonates.  Unilateral congenital dacryocystocele is more common but 12-25% of patients affected have bilateral lesions.  Ultrasound, CT scan or MRI can be used for diagnosis.  About half of the patient with acute dacryocystitis can be management with conservative management such as digital massage of lacrimal sac or in-office lacrimal duct probing.  The other half of patients will require surgery under general anesthesia for removal of the dacryocystocele.   Endoscopic excision of the intranasal cysts has been used successfully as a treatment option with Crawford stent placement.  Post-operatively patients are treated empirically with antibiotics and nasal saline.  No second look is usually planned unless patients develop significant nasal obstrctuion. Editor Recruited By: Sanjay Parikh, MD, FACS DOI: http://dx.doi.org/10.17797/16rnuq8n0y

Congenital nasal pyriform aperture stenosis (CNPAS) is defined as inadequate formation of the pyriform apertures forming the bony nasal openings resulting in respiratory distress and cyanosis soon after birth. Some clues such as worsening distress during feeding and improvement during crying may indicate a nasal cause of respiratory distress rather than distal airway etiology. Inability or difficulty passing a small tube through the nasal cavities may suggest CNPAS. The presenting clinical features of CNPAS can be  similar to other obstructive nasal airway anomalies such as choanal atresia. Diagnosis is confirmed via CT scan with a total nasal aperture less than 11mm. CNPAS may occur in isolation or it may be a sign of other developmental abnormalities such as holoprosencephaly, anterior pituitary abnormalities, or encephalocele. Some physical features of holoprosencephaly include closely spaced eyes, facial clefts, a single maxillary mega incisor, microcephaly, nasal malformations, and brain abnormalities (i.e. incomplete separation of the cerebral hemispheres, absent corpus callosum, and pituitary hormone deficiencies). It is important to rule out other associated abnormalities to ensure optimal treatment and intervention. Conservative treatment of CNPAS includes humidification, nasal steroids, nasal decongestants and reflux control. Failure of conservative treatment defined by respiratory or feeding difficulty necessitates more aggressive intervention. The most definitive treatment for CNPAS is surgical intervention to enlarge the pyriform apertures. Contributors: Adam Johnson MD, PhD Abby Nolder MD

Donghang Huang’s procedure, also termed as direct-access single-port endoscopy assisted mini-incision thyroidectomy, is a hybrid surgery conducted in the following 3 major steps: 1.A mini-incision of approximately 2.5-3 cm long on the central neck is made. A working space under the platysmal muscle or strap muscles for single-port endoscopic surgery is constructed with carbon dioxide insufflation (performed under direct vision). 2.Mobilization of the superior and inferior pole of the thyroid lobe, and exposure of the recurrent laryngeal nerve (performed under single-port endoscopy). 3.Extraction and resection of the thyroid lobe. (performed under direct vision). Donghang Huang's procedure can provide shorter incision and better cosmetic results while maintaining adequate exposure.

Surgical removal of suprastomal granuloma is a procedure performed prior to the probable decannulation of a tracheostomy. There are several ways of achieving this objective, but in certain cases, a KTP laser on a flexible delivery system offers a precise and controlled method to successful debulking of the granuloma with minimal risks of haemorrhage into the airway. DOI: http://dx.doi.org/10.17797/pqzu0ns9y9 Editor Recruited By: Sanjay Parikh, MD, FACS

Title: Full-thickness skin grafting for coverage of dorsal hand defect Authors: Vincent Riccelli, Brian Drolet MD, Elizabeth Lee MD Affiliations: Vanderbilt University Medical Center Corresponding Author: Vincent Riccelli (vincent.riccelli@vanderbilt.edu)

The G tube is then placed over the wire into the stomach. The balloon is inflated with half contrast, half saline and pulled back under fluoro to the abdominal wall and the grommet is synched down appropriately. Contrast should be injected into the G tube to confirm the tube is in the stomach and not past or against the pylorus. Air can be evacuated from the stomach. DOI#: https://doi.org/10.17797/e5fi2tvnd8