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We found 55 results for Arkansas Children\'s Hospital in webinar, video & news

webinar (6)

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Surgical Pitfalls, Early Career Advancement and Leadership
webinar

In this last Cardiothoracic DocTalk session of the Pathway to Independence for Junior Surgeons we will discuss early career mistakes and how to avoid them. Viewers of this webinar will learn tips and tricks learned from senior partners and knowing when to call for help.


Lawrence Greiten, MD

Assistant Professor in Division of Congenital Cardiac Surgery
Arkansas Children's Hospital (ACH) and the University of Arkansas for Medical Sciences (UAMS)

Lawrence Greiten, M.D., is an Assistant Professor in the Division of Congenital Cardiac Surgery at Arkansas Children’s Hospital (ACH) and the University of Arkansas for Medical Sciences (UAMS). Dr. Greiten received his undergraduate degree from Kansas Wesleyan University and his medical degree from the University Of Arizona College Of Medicine. He completed both his General Surgery training and Cardiovascular and General Thoracic Surgery fellowship at the Mayo School of Graduate Medical Education, where he also earned a Masters in Biomedical Sciences, Clinical and Translational Science. He did an advanced Fellowship in Congenital Cardiac Surgery at Children’s Hospital Los Angeles, Keck Medical School at the University of Southern California.

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Surgical Exposure, Minimal Incision Surgical Option for ASD Repair
webinar


In this second Cardiothoracic DocTalk session of the Pathway to Independence for Junior Surgeons we plan to discuss the approach to a Minimal Incision ASD. Our panel will discuss the merits of offering this approach along with the potential pitfalls. Viewers of this webinar will gain insight into optimizing surgical exposure and understanding when it is safe to proceed with less invasive techniques.


Lawrence Greiten, MD

Assistant Professor in Division of Congenital Cardiac Surgery
Arkansas Children's Hospital (ACH) and the University of Arkansas for Medical Sciences (UAMS)

Lawrence Greiten, M.D., is an Assistant Professor in the Division of Congenital Cardiac Surgery at Arkansas Children’s Hospital (ACH) and the University of Arkansas for Medical Sciences (UAMS). Dr. Greiten received his undergraduate degree from Kansas Wesleyan University and his medical degree from the University Of Arizona College Of Medicine. He completed both his General Surgery training and Cardiovascular and General Thoracic Surgery fellowship at the Mayo School of Graduate Medical Education, where he also earned a Masters in Biomedical Sciences, Clinical and Translational Science. He did an advanced Fellowship in Congenital Cardiac Surgery at Children’s Hospital Los Angeles, Keck Medical School at the University of Southern California.

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Pre-Operative Planning, Intraoperative Considerations and Troubleshooting
webinar

In this first Cardiothoracic DocTalk session of the Pathway to Independence for Junior Surgeons we will discuss Redo Sternotomy and Pulmonary Valve Replacement in a patient who had prior TOF repair. We plan to highlight the pre-operative strategy which will include necessary imaging and testing along with how to manage an intra-operative complication of air embolism. Viewers of this webinar will gain valuable insight into a stepwise approach to managing a very complex surgical scenario.


Lawrence Greiten, MD

Assistant Professor in Division of Congenital Cardiac Surgery
Arkansas Children's Hospital (ACH) and the University of Arkansas for Medical Sciences (UAMS)

Lawrence Greiten, M.D., is an Assistant Professor in the Division of Congenital Cardiac Surgery at Arkansas Children’s Hospital (ACH) and the University of Arkansas for Medical Sciences (UAMS). Dr. Greiten received his undergraduate degree from Kansas Wesleyan University and his medical degree from the University Of Arizona College Of Medicine. He completed both his General Surgery training and Cardiovascular and General Thoracic Surgery fellowship at the Mayo School of Graduate Medical Education, where he also earned a Masters in Biomedical Sciences, Clinical and Translational Science. He did an advanced Fellowship in Congenital Cardiac Surgery at Children’s Hospital Los Angeles, Keck Medical School at the University of Southern California.

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Cleft Lip Revision: Tips and Tricks
webinar

Attendees will learn various tips and tricks to a successful cleft lip revision procedure. There will be a Q&A session to address common challenges and how to address them.

Course Directors

Larry Hartzell, MD FAAP is an Associate Professor of Otolaryngology Head and Neck Surgery at Arkansas Children’s Hospital. He is the Director of the Pediatric Otolaryngology fellowship. Dr Hartzell also has been the Cleft Team Director in Arkansas since 2012. He is passionate about international humanitarian mission work and dedicates much of his research efforts to cleft surgical and clinical care as well as velopharyngeal insufficiency. Dr Hartzell is actively involved in multiple academic societies and organizations including the AAO-HNS and ACPA.

Dr. Goudy is a professor at Emory University School of Medicine and the director of the division of otolaryngology at Children’s Healthcare in Atlanta. Dr. Goudy’s clinical job involves repair of craniofacial malformations including cleft lip, cleft palate, and Pierre Robin sequence, and he also participates in head and neck tumor resection and reconstruction.

Panelists

Lauren K. Leeper, MD, FACS
Ashley E. Manlove DMD, MD, FACS

Dr. Leeper completed her residency training in Otolaryngology--Head & Neck Surgery at the Medical University of South Carolina in 2012 and fellowship training in Pediatric Otolaryngology at Arkansas Children's Hospital in 2014.  She returned to the University of North Carolina - Chapel Hill in 2014 on faculty in the Department of Otolaryngology--Head & Neck Surgery.  She is the current Fellowship Director and Medical Director of the Children's Cochlear Implant Center.  She is married to Bradley and they have one daughter Sutton and a baby boy arriving this month.

Dr. Manlove joined Carle Foundation Hospital in 2016 as a fellowship trained cleft and craniomaxillofacial surgeon. She is the director of the cleft and craniofacial team at Carle. In 2018 she was name “Rising Star Physician” and that same year she also became the residency program director. Outside of work, she loves spending time with her family and she is an avid runner.

Deborah S. F. Kacmarynski, MD, MS
Jordan Swanson, MD, MSc

Dr. Kacmarynski is a Clinical Associate Professor in the Department of Otolaryngology-Head & Neck Surgery at the University of Iowa, working as a pediatric otolaryngologist and a cleft and craniofacial surgeon with co-directorship for the cleft and craniofacial team at the University of Iowa. Research focus is on biomedical collaborations with oral cleft and craniofacial surgical problems including craniofacial airway, tissue engineering solution development, outcomes research and patient-centered outcomes research collaboratives. I am excited about the long-term impacts of research leading very directly to significant improvements in our patients’ healing and growth.

Jordan Swanson, MD, MSc, is an attending surgeon in the Division of Plastic, Reconstructive and Oral Surgery at Children’s Hospital of Philadelphia with special clinical expertise in cleft, craniofacial, and pediatric plastic surgery. He holds the Linton A. Whitaker Endowed Chair in Plastic, Reconstructive and Oral Surgery.

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Alveolar Bone Graft Surgery: Tips and Tricks
webinar

This webinar will focus on the surgical management of alveolar clefts with bone grafting and fistula closure. Our panel of experts will share various techniques and graft source materials including tips and tricks learned along the way. Our guest moderator will lead a panel discussion at the end of the session to discuss some of the controversies and key points in alveolar grafting.

Dr. Larry Hartzell
Director of Cleft Lip and Palate / Pediatric ENT Surgeon @ Arkansas Children's Hospital / University of Arkansas for Medical Sciences
Dr. Steven Goudy
Professor / Director of Division of Otolaryngology @ Emory University School of Medicine / Children's Healthcare in Atlanta
Larry Hartzell, MD FAAP is an Associate Professor of Otolaryngology Head and Neck Surgery at Arkansas Children’s Hospital. He is the Director of the Pediatric Otolaryngology fellowship. Dr Hartzell also has been the Cleft Team Director in Arkansas since 2012. He is passionate about international humanitarian mission work and dedicates much of his research efforts to cleft surgical and clinical care as well as velopharyngeal insufficiency. Dr Hartzell is actively involved in multiple academic societies and organizations including the AAO-HNS and ACPA.Dr. Goudy is a professor at Emory University School of Medicine and the director of the division of otolaryngology at Children’s Healthcare in Atlanta. Dr. Goudy’s clinical job involves repair of craniofacial malformations including cleft lip, cleft palate, and Pierre Robin sequence, and he also participates in head and neck tumor resection and reconstruction.
Travis T. Tollefson MD MPH FACS
Professor & Director of Facial Plastic & Reconstructive Surgery
@ University of California Davis
Mark E. Engelstad DDS, MD, MHI
Associate Professor of Oral and Maxillofacial Surgery @ Oregon Health & Science University
Dr. Tollefson is a Professor and Director of Facial Plastic & Reconstructive Surgery at the University of California Davis, where he specializes in cleft and pediatric craniofacial care, facial reconstruction and facial trauma care. His interest in the emerging field of Global Surgery and improving surgical access in low-resource countries led him to complete an MPH at the Harvard School of Public Health. He helps lead the CMF arm of the AO-Alliance.org, whose goal is to instill AO principles in facial injuries in low resource settings. His current research focuses on clinical outcomes of patients with cleft lip-palate, facial trauma education in Africa, patterns of mandible fracture care, and patient reported outcomes in facial paralysis surgeries. He serves on the Board of Directors of the American Board of Otolaryngology- Head and Neck Surgery, American Academy of Facial Plastic Surgery, and is the Editor-In-Chief for Facial Plastic Surgery and Aesthetic Medicine journal.Mark Engelstad is Associate Professor and Program Director of Oral and Maxillofacial surgery at Oregon Health & Science University in Portland, Oregon. His clinical practice focuses on the correction of craniofacial skeletal abnormalities, especially orthognathic surgery and alveolar bone grafting.
John K. Jones, MD, DMD
Associate Professor in Oral and Maxillofacial Surgery @ University of Arkansas for Medical Sciences / Arkansas Children’ Hospital
David Joey Chang, DMD, FACS
Associate Professor of Oral and Maxillofacial Surgery @ Tufts University/Tufts Medical Center
Dr. Jones has over 30 years of experience in the surgical management of cleft lip and palate with particular experience in the area of alveolar ridge grafting and corrective jaw surgery. He has been a member of the Cleft Lip and Palate Team at Arkansas Children’s Hospital for the last six years. During that time he has worked with Dr. Hartzell and his team to introduce and innovate new techniques, many from the realm of Oral and Maxillofacial Surgery and Dentistry, in the interest of improving outcomes for this most challenging patient population.Dr. Chang is an associate professor at Tufts University School of Medicine and Tufts Medical Center. Dr. Chang is involved in the Cleft Team at Tufts Medical center since 2012. He also focuses on advanced bone grafting procedures, TMJ surgery, and nerve reconstruction.

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Three Stage Management of the Single Ventricle
webinar

In this session our team of experts will discuss the three stages of single ventricle palliation including the Norwood procedure, the bidirectional Glenn shunt and the Fontan procedure. Included in this webinar will be single ventricle pathophysiology, diagnostic studies/imaging, indications and contraindications for palliation, timing of surgical intervention, and overview of surgical goals and associated mortality.


Assistant Professor in Division of Congenital Cardiac Surgery
Arkansas Children's Hospital (ACH) and the University of Arkansas for Medical Sciences (UAMS)

Lawrence Greiten, M.D., is an Assistant Professor in the Division of Congenital Cardiac Surgery at Arkansas Children’s Hospital (ACH) and the University of Arkansas for Medical Sciences (UAMS). Dr. Greiten received his undergraduate degree from Kansas Wesleyan University and his medical degree from the University Of Arizona College Of Medicine. He completed both his General Surgery training and Cardiovascular and General Thoracic Surgery fellowship at the Mayo School of Graduate Medical Education, where he also earned a Masters in Biomedical Sciences, Clinical and Translational Science. He did an advanced Fellowship in Congenital Cardiac Surgery at Children’s Hospital Los Angeles, Keck Medical School at the University of Southern California.

Research Intern
Arkansas Children’s Research Institution / University of Arkansas for Medical Sciences

Sophia is a Pre-Medical Track student that recently graduated with a traditional BA-Biology degree and a minor in Medical Humanities. She is always seeking to expand her knowledge and gain exposure to pediatric research in hopes of bettering herself as an aspiring physician and continuing research in the future.

CVOR Surgical Assistant Chief
Arkansas Children's Hospital

Over 28 years of adult and congenital heart surgery experience. I have helped develop a minimally invasive and robotic surgery program at UCLA. In addition, I have been involved with Ex-Vivo heart and lung preservation trials and several drug trials.

Professor, Department of Surgery / Director, Heart Institute
UAMS College of Medicine / Arkansas Children’s Hospital

Brian Reemtsen, M.D. is a Professor at the University of Arkansas for Medical Sciences in the Division of Pediatric Cardiothoracic Surgery at Arkansas Children’s Hospital. He is also Director of the Heart Institute at Arkansas Children’s Hospital. He received his undergraduate degree from the University of California at Los Angeles (UCLA), and his medical degree from New York Medical College. He completed his internship and residency at UCLA School of Medicine. He then completed fellowships at the University of Washington, as well as the Great Ormond Street Hospital in London, England.

video (48)

Repair of a Non-coronary Sinus of Valsalva Aneurysm Rupture
video

A brief patient history is given, followed by preoperative imaging, intraoperative repair, and postoperative imaging.

Sinus Venosus ASD Repair
video

This video demonstrates a sinus venosus ASD repair with the two patch repair technique. Authors: Emily Goodman; Brian Reemtsen, MD; Markus Renno, MD; Christian Eisenring, ACNP-BC; Lawrence Greiten, MD University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR Arkansas Children's Hospital, Little Rock, AR

Complete Repair of Total Anomalous Venous Return
video

Complete repair of a total anomalous pulmonary venous return. Also shown is a primary closure of a patent foramen ovale and patent ductus arteriosus. The patient is placed on cardiopulmonary bypass (CPB) in the standard fashion. The patient is then crash cooled to 20 degrees celsius with ice placed on the head and administration of steroids. Antegrade cardioplegia is then administered. The large confluent vein (vertical vein) is dissected and an arteriotomy is made, a subsequent atriotomy is made in the left atrial appendage. A side to side anastomosis using polypropylene suture in a continuous running fashion. The right atrium is then opened and the patent foramen ovale is closed. The patient was warmed to a satisfactory temperature and once adequate hemostasis was achieved the vertical vein is ligated at its insertion into the innominate vein.

Minimal incision Partial Sternotomy ASD Repair
video

This video showcases a minimal incision, partial sternotomy exposure for complete ASD patch repair performed at Arkansas Children's Hospital.

Sinus Venosus ASD Repair
video

This video demonstrates a sinus venosus ASD repair with the two patch repair technique. Authors: Emily Goodman; Brian Reemtsen, MD; Markus Renno, MD; Christian Eisenring, ACNP-BC; Lawrence Greiten, MD University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR Arkansas Children's Hospital, Little Rock, AR

Pulmonary Valve Replacement
video

This video highlights a pulmonary valve replacement in a patient with Tetralogy of Fallot. 

Minimal Incision Partial Sternotomy ASD Repair
video

This video showcases a minimal incision, partial sternotomy exposure for complete ASD patch repair performed at Arkansas Children's Hospital.

Sliding Osseous Genioplasty and Coronoidectomy in a Patient with Treacher-Collins Syndrome
video

Contributors: Andrew Weaver and Kumar Patel, PA-C 18 y.o. female with Treacher-Collins syndrome (patients have micrognathia, underdeveloped facial bones, particularly the cheek bones, and a very small jaw and chin. She is only able to open her mouth to 20mm due to the interference of her coronoid process with her zygoma/ DOI: http://dx.doi.org/10.17797/959yiezvoo

Superior Rectus Recession
video

Introduction Muscle recession is a type of strabismus surgical procedure that aims to weaken an extraocular muscle by adjusting its insertion posteriorly closer to its origin. The patient is a 14-year-old with dissociated vertical deviation, which can be corrected with recession of the superior rectus muscle. Methods A conjunctival incision is made in the fornix. Tenon's capsule is dissected to expose the superior rectus muscle. The superior rectus muscle is isolated using a Stevens tenotomy hook followed by a Jameson muscle hook. After the remaining Tenon's attachments are cleared, the muscle is secured at both poles with a double-armed 6-0 VicrylTM suture and double-locking bites. The muscle is then disinserted from the sclera with Manson-Aebli scissors. A caliper is used to mark the predetermined distance of muscle reinsertion. Next, the muscle is reattached to the sclera with partial thickness bites and then tied down to its new location. The conjunctival incision is closed with 6-0 plain gut sutures. Results No complications arose during the procedure. Postoperatively, the patient had subconjunctival hemorrhage, injection, and pain that decreased over the following week. Neomycin-polymyxin-dexamethasone drops were applied daily to prevent infection and inflammation. At the three-month follow up, the redness had resolved. The dissociated vertical deviation had improved. Conclusion Superior rectus recession is a safe procedure that can effectively treat vertical strabismus. By: Michelle Huynh College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA mhuynh@uams.edu Surgeons: Brita Rook, MD Arkansas Children’s Hospital – Department of Ophthalmology, Little Rock, Arkansas, USA BSRook@uams.edu Joseph Fong, MD Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA JFong@uams.edu Video was performed at Arkansas Children’s Hospital, Little Rock, AR, USA.

Redo Posterior Fossa Decompression with Duraplasty for the Treatment of Chiari Type I Malformation
video

Chiari decompression is a common neurosurgical procedure. Chiari malformations present with a number of symptoms including Valsalva-induced headaches, swallowing dysfunction, and sleep apnea. Chiari malformations can also cause syringomyelia and syringobulbia. Surgical procedures used for the treatment of Chiari malformation include bone-only decompression (posterior fossa craniectomy +/- cervical laminectomy), craniectomy/laminectomy with duraplasty, and craniectomy/laminectomy/duraplasty with shrinkage or resection of the cerebellar tonsils. The procedure used depends on the specifics of the patient’s condition and the preference of the surgeon. The patient presented here had undergone a prior Chiari decompression at the age of 20 months. This was bone-only with posterior fossa craniectomy and C1-2 laminectomy. The dura was not opened due to the presence of a venous lake. He initially had improvement in his symptoms. However, his headaches and snoring recurred, balance worsened, and dysphagia never improved. Therefore, a repeat Chiari decompression at the age of 28 months was performed as presented here.

Plastic Surgery Pearls for basic suturing: instruments & technique
video

Contributors: Kumar Patel, PA-C Basic plastic surgery suturing techniques geared towards medical students and residents, including starting position, basic simple suture, deep dermal suture, vertical mattress, horizontal mattress and running subcuticular. DOI: http://dx.doi.org/10.17797/udwdtpze6v

Microdebrider Assisted Lingual Tonsillectomy
video

Microdebrider Assisted Lingual Tonsillectomy Adrian Williamson, Michael Kubala MD, Adam Johnson MD PhD, Megan Gaffey MD, and Gresham Richter MD The lingual tonsils are a collection of lymphoid tissue found on the base of the tongue. The lingual tonsils along with the adenoid, tubal tonsils, palatine tonsils make up Waldeyer’s tonsillar ring. Hypertrophy of the lingual tonsils contributes to obstructive sleep apnea and lingual tonsillectomy can alleviate this intermittent airway obstruction.1,2 Lingual tonsil hypertrophy can manifest more rarely with chronic infection or dysphagia. A lingual tonsil grading system has been purposed by Friedman et al 2015, which rates lingual tonsils between grade 0 and grade 4. Friedman et al define grade 0 as absent lingual tonsils and grade 4 lingual tonsils as lymphoid tissue covering the entire base of tongue and rising above the tip of the epiglottis in thickness.3 Lingual tonsillectomy has been approached by a variety of different surgical techniques including electrocautery, CO2 laser, cold ablation (coblation) and microdebridement.4-9 Transoral robotic surgery (TORS) has also been used to improve exposure of the tongue base to perform lingual tonsillectomy.10-13 At this time, there is not enough evidence to support that one of these techniques is superior. Here, we describe the microdebrider assisted lingual tonsillectomy in an 8 year-old female with Down Syndrome. This patient was following in Arkansas Children's Sleep Disorders Center and found to have persistent moderate obstructive sleep apnea despite previous adenoidectomy and palatine tonsillectomy. Unfortunately, she did not tolerate her continuous positive airway pressure (CPAP) device. The patient underwent polysomnography 2 months preoperatively which revealed an oxygen saturation nadir of 90%, an apnea-hypopnea index of 7.7, and an arousal index of 16.9. There was no evidence of central sleep apnea. The patient was referred to otolaryngology to evaluate for possible surgical management. Given the severity of the patient’s symptoms and clinical appearance, a drug induced sleep state endoscopy with possible surgical intervention was planned. The drug induced sleep state endoscopy revealed grade IV lingual tonsil hypertrophy causing obstruction of the airway with collapse of the epiglottis to the posterior pharyngeal wall. A jaw thrust was found to relieve this displacement and airway obstruction. The turbinates and pharyngeal tonsils were not causing significant obstruction of the airway. At this time the decision was made to proceed with microdebrider assisted lingual tonsillectomy. First, microlaryngoscopy and bronchoscopy were performed followed by orotracheal intubation using a Phillips 1 blade and a 0 degree Hopkins rod. Surgical exposure was achieved using suspension laryngoscopy with the Lindholm laryngoscope and the 0 degree Hopkins rod. 1% lidocaine with epinephrine is injected into the base of tongue for hemostatic control using a laryngeal needle under the guidance of the 0 degree Hopkins rod. 1. The 4 mm Tricut Sinus Microdebrider blade was set to 5000 RPM and inserted between the laryngoscope and the lips to resect the lingual tonsils. Oxymetazoline-soaked pledgets were used periodically during resection to maintain hemostasis and proper visualization. A subtotal lingual tonsillectomy was completed with preservation of the fascia overlying the musculature at the base of tongue. She was extubated following surgery and there were no postoperative complications. Four months after postoperatively the patient followed up at Arkansas Children's Sleep Disorders Center and was found to have notable clinical improvement especially with her daytime symptoms. A postoperative polysomnography was not performed given the patient’s clinical improvement.

Excision of Scalp Congenital Hemangioma
video

Contributors: Adam Johnson, MD and Gresham Richter, MD, FACS Noninvovluting Congenital Hemangioma (NICH) is a congenital vascular lesion present at birth. These lesions do not regress, in contrast to infantile hemangioma or Rapidly Involuting Congenital Hemangioma (RICH), and may grow proportionately with age. Most lesions present in the head and neck, trunk, or limbs, and can be painful. Surgical excision is the treatment of choice. DOI #: http://dx.doi.org/10.17797/5hq5nro3j4

Cranioplasty for Sagittal Craniosynostosis
video

Cranioplasty with barrel stave osteotomies to treat sagittal suture craniosynostosis.

Pressure Equalization Tube Placement
video

Contributor: Gresham T. Richter, MD (Arkansas Children's Hospital) Pressure equalization tube placement is one of the most common procedures in the pediatric population. This video demonstrates the surgeon's view of the right ear through the operative microscope. Indications: recurrent otitis media with effusion, chronic otitis media with effusion (>3 months duration), speech/language delay secondary to otitis. Instruments: operative microscope, ear speculum, ear curette, myringotomy knife, suction tube, pressure equalization tube Procedure Steps: 1. Speculum inserted into external auditory canal 2. Cerumen removed with the curette (not shown in video) 3. Myringotomy performed on anterior-inferior quadrant of tympanic membrane 4. Fluid aspirated with suction tube 5. Pressure equalization tube (PET) inserted and secured 6. Antibiotic otic drops applied 7. Cotton dressing applied Recommended Resource: Lambert E, Roy S. Otitis media and ear tubes. Pediatric Clinics of North America. 2013;60(4):809-26. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23905821 The authors have no conflicts of interest or financial disclosures. DOI: http://dx.doi.org/10.17797/fzlqossgrh

Tonsillectomy Using Electrocautery
video

Contributors: Conor Smith (Arkansas Children's Hospital) and Gresham Richter M.d. (Arkansas Children's Hospital) The removal of tonsils is most often indicated by tonsillar hypertrophy contributing to obstructive sleep apnea or chronic/recurring throat infections from pathogens such as streptococcal bacteria. Electrocautery is the most commonly used technique to safely and effectively excavate the tonsils. DOI: http://dx.doi.org/10.17797/cb233d20mk

Endoscopic Excision of Concha Bullosa
video

Contributors: Gresham Richter Here we present endoscopic excision of a concha bullosa (a pneumatized middle turbinate) that was causing obstruction in the left nasal cavity.  This particular patient failed medical management of his chronic sinusitis including antibiotic and steroid therapy. The concha bullosa was causing obstruction of the maxillary sinus ostium and deviation of the nasal septum. Resection of the concha bullosa was necessary in order to complete a functional endoscopic sinus surgery afterward and septoplasty (not shown). DOI # 10.17797/pyzfxehca8 Author Recruited by: Gresham Ritcher

Congenital Nasal Pyriform Aperture Stenosis (CNPAS): Sublabial Approach to Surgical Correction
video

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

Mandibular Distraction for Micrognathia in a Neonate
video

Introduction Patients with Pierre-Robin Sequence (PRS) suffer from micrognathia, glossoptosis, and upper airway obstruction, which is sometimes associated with cleft palate and feeding issues. To overcome these symptoms in our full-term male neonate patient with PRS, mandibular distraction osteogenesis was performed. Methods The patient was intubated after airway endoscopy. A submandibular incision was carried down to the mandible. A distractor was modified to fit the osteotomy site that we marked, and its pin was pulled through an infrauricular incision. Screws secured the plates and the osteotomy was performed. The mandible was distracted 1.8 mm daily for twelve days. Results During distraction, the patient worked with speech therapy. Eventually, he adequately fed orally. He showed no further glossoptosis or obstruction after distraction was completed. Conclusion In our experience, mandibular distraction is a successful way to avoid a surgical airway and promote oral feeding in children with PRS and obstructive symptoms. By: Ravi W Sun, BE Surgeons: Megan M Gaffey, MD Adam B Johnson, MD, PhD Larry D Hartzell, MD Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA Arkansas Children's Hospital, Little Rock, AR, USA Recruited by: Gresham T Richter, MD

Le Fort I Osteotomy with placement of Distractor
video

Our patient is a 20 year old boy with severe maxillary hypoplasia with a history of bilateral cleft lip and palate. We performed a maxillary advancement with distraction osteogenesis. Nikhil Kamath, BS Aaron Smith, MD Michael S. Golinko, MD Kumar Patel, PA-C

Revision Facial Bipartition Osteotomy
video

Revision Facial Bipartition Osteotomy in 14y/o Female. Contributors: Aaron Smith, MD; Kumar Patel, PA; Ashley Bartels, BS; Rongsheng Cai, MD; Roop Gill, MD

Excision of Macrocystic Lymphatic Malformation
video

Introduction Lymphatic malformations (LM) are composed of dilated, abnormal lymphatic vessels classified as macrocystic (single or multiple cysts >2 cm3), microcystic (<2 cm3), or mixed. This patient is a 5-month-old with a right neck mass consistent with macrocystic lymphatic malformation on MRI. This low-flow vascular malformation required surgical intervention. Methods The site was marked in a natural skin crease. Subplatysmal flaps were raised and malformation was immediately encountered. Blunt soft tissue dissection was performed immediately adjacent to the mass to reflect tissue off the fluid-filled lesion. Neurovascular structures were preserved in this process. Mass was removed in total and Penrose drain and neck dressing were placed. Results A complete resection was performed. LM was confirmed on pathology. Patient is doing well with no deficits noted. The drain was removed after 1 week. One-month follow-up showed no recurrence. Conclusion Macrocystic lymphatic malformations are amenable to surgical resection at low risk and without recurrence. By: Ravi W Sun, BE Surgeons: Luke T Small, MD Gresham Richter, MD Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA Arkansas Children's Hospital, Little Rock, AR, USA Recruited by: Gresham T Richter, MD

Tympanoplasty with tragal cartilage graft, postauricular approach
video

Tympanoplasty with tragal cartilage graft, postauricular approach Blake Hollowoa, Michael Kubala, Gresham Richter. Introduction Tympanic membrane (TM) perforations arise from multiple conditions including acute otitis media, barotrauma, chronic eustachian tube dysfunction, or as a complication of pressure equalization (PE) tube insertion. Most perforations heal spontaneously or with conservative measures such as ototopical drops and dry ear precautions. Perforations that do not heal can lead to conductive hearing loss, chronic infection, or cholesteatoma. A 6-year-old patient with a persistent TM perforation presented with otalgia and otorrhea. A tympanoplasty with a tragal cartilage graft was performed to repair the patient’s TM perforation. Methods The patient was intubated and the operation carried out under general anesthesia. Facial electrodes were inserted for facial nerve monitoring. The patient was prepped and draped in sterile fashion. The external canal was suctioned and irrigated. A tragal incision was then made to harvest a 1 cm piece of cartilage for the TM graft. The tragal incision was closed with monocryl suture. A postauricular incision was made in the natural skin crease to expose the posterior canal. Canal incisions were made to enter the external canal. A tympanomeatal flap was elevated until the middle ear was entered. The previously harvested tragal cartilage graft was inserted medial to the native TM perforation. Gel-Foam was inserted medial to the graft for support. Tragal perichondrium was inserted lateral to the tragal cartilage graft. Gel-Foam was then inserted lateral to the graft for support. The periosteum and postauricular incision were closed with vicryl suture. The external canal was inspected, then antibiotic ointment and an ear wick was inserted. The patient was dressed using a Glasscock dressing. Results The patient was discharged the same day and seen in clinic two weeks from his surgery. The incisions were healing well with no indications of infection or wound dehiscence. His pain was resolved and an appointment for formal audiology was scheduled for a 3-month follow-up visit. Conclusion Tympanoplasty with a tragal cartilage graft using a postauricular approach is a successful method to surgically correct persistent tympanic membrane perforations.

Superiorly Based Pharyngeal Flap for Velopharyngeal Dysfunction
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Velopharyngeal dysfunction (VPD) refers to the improper control of airflow through the nasopharynx. The term VPD denotes the clinical finding of incomplete velopharyngeal closure. Other terms used to describe VPD include velopharyngeal insufficiency, inadequacy and incompetence. However, the use of VPD has gained popularity over these terms as they may be used to infer a specific etiology of impaired velopharyngeal closure.1 Control of airflow through the nasopharynx is dependent on the simultaneous elevation of the soft palate and constriction of the lateral and posterior pharyngeal walls. Disruptions of this mechanism caused by structural, muscular or neurologic pathology of the palate or pharyngeal walls can result in VPD. VPD can result in a hypernasal voice with compensatory misarticulations, nasal emissions and aberrant facial movements during speech.2 The assessment of velopharyngeal function is best preformed by a multispecialty team evaluation including speech-language pathologists, prosthodontists, otolaryngologists and plastic surgeons. The initial diagnosis of VPD is typically made with voice and resonance evaluation conducted by a speech-language pathologist. To better characterize the patient’s VPD, video nasopharyngeal endoscopy or speech videofluoroscopy can be used to visualize the velopharyngeal mechanism during speech. VPD may first be managed with speech-language therapy and removable prostheses. For those who are good surgical candidates and do not fully respond to speech-language therapy, surgical intervention may be pursued. Surgical management of VPD is most commonly accomplished by pharyngeal flap procedures or sphincter pharyngoplasty. In this video, a superiorly based pharyngeal flap with a uvular mucosal lining flap was preformed for VPD in a five-year-old patient with 22q11 Deletion Syndrome and aberrantly medial internal carotid arteries.

Custom PMMA implant and DBX Cranioplasty for large cranial calavarial defects
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Following a post-traumatic head injury from a gun shot wound in a seven year old African American female, a 3D CT was performed to assess for correction of a large cranial calavarial defect using a custom PMMA implant. A trilaminar Cranioplasty was planned using an absorbable plate underlay, demineralized bone graft in between and an onlay of absorbable plate. A post-operative CT was obtained showing the implant in a good position.

Endoscopic Third Ventriculostomy for Non-communicating, Obstructive Hydrocephalus
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An endoscopic third ventriculostomy (ETV) can be a sufficient alternative to a cerebral shunt in the treatment of noncommunicating forms of hydrocephalus. Hydrocephalus can present with numerous signs and symptoms, including headache, vomiting, neck pain, macrocephaly, and vision impairment. Surgical procedure includes entrance of the lateral ventricles through a bur hole, and blunt/cautery fenestration of the third ventricular floor, which lies between the mamillary bodies and tuber cinereum. Choroid plexus cautery has been noted in the literature as being a viable addition to the procedure, in which a reduction in CSF production is achieved. Though, exact surgical procedure is left to the discretion of the surgeon. The patient presented is a 30-month-old boy with non-communicating obstructive hydrocephalus secondary to congenital aqueductal stenosis. The patient has a history of progressive developmental delays, balance issues, and increased seizure frequency from a known seizure disorder. Therefore, an endoscopic third ventriculostomy via right frontal approach was elected. Authors: William Fuell, Marcus Stephens M.D., Eylem Ocal M.D. Institutions: Arkansas Children's Hospital, University of Arkansas for Medical Sciences

Excision of Macrocystic Lymphatic Malformation
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This patient is a 9-month-old with a macrocystic lymphatic malformation (LM) of the left neck. LMs, the second most common type of head and neck vascular malformation, are composed of dilated, abnormal lymphatic vessels thought to occur due to abnormal development of the lymphatic system. A complete resection was performed, and LM was confirmed by pathology. Soft tissue dissection was performed immediately adjacent to the mass to reflect tissue off the fluid-filled lesion. Neurovascular structures were preserved in this process.

Implantation of Tissue Expander in Poland Syndrome Patient
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This patient is a seventeen-year-old female with Poland syndrome, resulting in a hypotrophic left pectoralis major muscle and rib anomalies. A tissue expander is implanted on the left side to increase the capacity of the left breast tissue in order to make room for a future, permanent implant.

Excision of Lymphatic Malformation of Tongue
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The patient was then nasotracheally intubated, prepped and draped in sterile fashion and the tongue injected with 2 cc lidocaine with epi. Bovie was used to incise lesion in ellipse down to its base which was sent for pathology. A tongue stitch was used for traction. Hemostasis was also achieved with Bovie. The site was closed primarily with vicryl, deep and superficial. Bipolar was used to treat small surface lesions. All instrumentation was then removed and the patient was turned back over to anesthesia, awakened, and transferred to the recovery room extubated in stable condition.

Orbital Decompression through Conjuctival and Lynch Incisions
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Surgical orbital decompression for proptosis secondary to Graves' Disease.

Upper Eyelid Blepharoplasty
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Introduction: Cosmetic Upper Blepharoplasty involves removing excess skin from the upper eyelid to enhance the appearance of the upper eyelids. Methods: Markings were made for the inferior incision on the upper eyelid between 8-10 mm above the upper lash line. Forceps are used to pinch the excess upper eyelid skin in the middle, nasal, and temporal, aspects of the upper eyelid. Markings are then made superiorly at the middle, nasal, and temporal points and are connected. Toothed forceps are used to pinch the excess upper eyelid skin, using the markings as a guide. Iris scissor is used to excise the pinched excess skin and the underlying orbicularis muscle. The skin between the two eyelids was closed. Conclusions: In our experience, cosmetic upper blepharoplasty is an efficient way to enhance the appearance of the eyes. By: Peyton Yee, Addison Yee Surgeon: Suzanne Yee, MD, FACS Dr. Suzanne Yee Cosmetic and Laser Surgery Center, Little Rock, AR, USA Recruited by: Gresham T Richter, MD

Bilateral Wise Pattern Inferior Pedicle Reduction Mammoplasty
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We present a 16-year-old female with hypertrophic breasts of bra size 38H, bra strap grooving, and worsening back and posterior shoulder pain limiting activity and affecting posture, who underwent bilateral reduction mammoplasty using the Wise pattern inferior pedicle technique. 998 g of tissue was removed from the patient’s right breast, and 852 g of tissue was removed from the patient’s left breast. The procedure was uncomplicated; however, the postoperative period was complicated by minor skin breakdown at the most inferior portion of the incision along the inframammary fold, as well as some serous drainage that shortly resolved with treatment. Overall, the patient is satisfied with the results of the reduction. She reports comfortably wearing size 38C bras and has noticed significant improvement in back pain, shoulder pain, and bra strap grooving six months after the procedure.

Excision of a Preauricular Cyst
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Background Preauricular cysts are a subset of asymptomatic, dome-shaped lesions referred to as epidermoid cysts. Cysts vary in size and have the ability to grow in diameter over time. These cysts can occur anywhere on the body and usually contain keratin. Upon examination of a suspected cyst, different characteristics can specify its type. Dermoid cysts are typically odorous lesions found around the eyes or on the base of the nose. If the cyst did not originate from sebaceous glands, it is not deemed a sebaceous cyst. Typically, surgical intervention is required to fully remove the cyst and prevent further infections or growth.  Introduction The video shows an 18-year-old female who presented with a preauricular cyst near her left ear. Upon history and physical examination, the mass was predicted to be a dermoid cyst rather than a sebaceous cyst. Surgical recommendations were given to perform an excisional biopsy of the cyst. The excision is displayed step-wise in the video. Methods A 2 cm incision was made just posterior to the lesion with a 15 blade scalpel. Dissection was carried with a sharp hemostat down the level of the parotid fascia. A 1 cm cystic structure was found adherent to the overlying dermis. An elliptical incision was then made over the mass and it was removed with the adherent overlying skin. The wound was then irrigated. Wound was closed in 3 layers. First, the deep layer was closed with 5-0 PDS in interrupted fashion, followed by 5-0 monocryl in running subcuticular fashion, followed by Dermabond Results The patient was returned to the care of anesthesia where she was awoken, extubated, and transported to PACU in stable condition. The patient tolerated the procedure well and was discharged the same day. The specimen was sent for pathological analysis. The pathology report showed that the mass was an epidermal inclusion cyst.

Fully Endoscopic Uniportal Interlaminar Microdiscectomy
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The conventional approach to the lumbar discectomy requires significant tissue dissection to obtain a sufficient working space and is known to cause possible complications and injuries. The minimally invasive, fully endoscopic uniportal interlaminar discectomy provides numerous advantages to the typical open procedure. Some advantages include: good visualization of anatomical structures utilizing continuous lavage; lower rates of operative complications such as dural injury, bleeding, and infection; and shorter hospitalization, with increased post-operative rehabilitation. Surgical procedure utilizes guided fluoroscopy to gain access to the interlaminar window, with subsequent placement of the working channel endoscope. Microscopic debridement of herniated lumbar disc and decompression of nerve roots is conducted. This case highlights a patient with significant disc herniation at the L5-S1 level with concurrent mild to moderate cervicothoracic scoliosis. The patient elected for the minimally invasive, fully endoscopic interlaminar microdiscectomy. Authors: William Fuell, Eylem Ocal M.D., Salih Aydin M.D. Institutions: Emsey Hospital-Istanbul, Arkansas Children’s Hospital

Bilateral Subcranial Le Fort III Osteotomies with Midface Distraction – A Surgical Review
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In this video, we showcase the bilateral subcranial Le Fort III osteotomies with midface distraction using Kawamoto distractors. The surgery was performed in a 4-year-old boy with Crouzon Syndrome to correct his severe proptosis, increase the nasopharyngeal airway space and improve his severe negative overjet. Internal distractors were chosen to achieve maximum correction at this age. The patient undergoing surgery had no intraoperative or postoperative complications. A full separation of his facial bones was achieved. The patient had an uneventful recovery period, and there was a significant improvement in his proptosis and malocclusion. Santiago Gonzalez, BS, BA (1); Michael Golinko, MD, MS (2) 1. University of Arkansas for Medical Sciences – College of Medicine 4301 W. Markham, #550 Little Rock, AR 72205 2. Vanderbilt University Medical Center, Department of Plastic Surgery 2900 Children’s Way, 9th Floor Doctor’s Office Tower Nashville TN 37232

Pediatric Tracheostomy
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The following video demonstrates the authors' method for performing a tracheostomy in a pediatric patient. Details of important anatomical landmarks and surgical technique are demonstrated in the video. Authors: Chrystal Lau, BA. University of Arkansas for Medical Sciences. Brad Stone, BA. University of Arkansas for Medical Sciences. Austin DeHart, MD. Arkansas Children's Hospital. Michael Kubala, MD. University of Arkansas for Medical Sciences. Gresham Richter, MD. Arkansas Children's Hospital.

Inferior Turbinate Trim
video

Basic Info: A 14-year-old male presented with chronic nasal obstruction and awake stertor. It was discovered that the patient had severe bilateral turbinate hypertrophy. A trial of Flonase and antihistamine was attempted with no improvement. It was recommended that the patient undergo a bilateral nasal turbinate reduction. This procedure is displayed step-wise in the video. Introduction: Chronic nasal obstruction can be caused by inferior turbinate hypertrophy. This video portrays a surgical treatment for turbinate hypertrophy, a turbinate trim with a microdebrider blade. Methods: An Afrin pledget was inserted into each nostril and lidocaine was injected into each inferior turbinate. Each turbinate was medially fractured using a freer. The microdebrider blade was used to trim the inferior 1/3 of each turbinate. A freer was used to out-fracture each inferior turbinate. Afrin pledgets were inserted into each nostril for hemostasis. Results: The inferior one-third of each inferior turbinate was removed via a microdebrider. Patient was sent to recovery in good condition, and Afrin pledgets were removed in recovery once hemostasis was achieved. No adverse reactions were reported by the surgeon or patient. Conclusion: Chronic nasal obstruction can be significantly improved by an inferior turbinate trim and out-fracture. Author: Merit Turner, BS, BS Surgeon: Gresham T. Richter, MD Institutions: Department of Otolaryngology-Head and Neck Surgery, Arkansas Children’s Hospital, Little Rock, AR University of Arkansas for Medical Sciences, Little Rock, AR

Laryngeal Papillomatosis with Microlaryngoscopy and Bronchoscopy with Microdebridement, CO2 Laser Ablation, and Cidofovir Injections.
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Anna Celeste Gibson, B.S., Mariah Small, M.D., Gresham Richter, M.D. University of Arkansas for Medical Sciences, Arkansas Children's Hospital Introduction: A papilloma is a benign tumor that is caused by human papillomavirus (HPV) commonly due to the strains 6 and 11. Children acquire these tumors intrapartum from an infected mother. HPV infects natural and metaplastic squamous mucosa which is the type of epithelium that lines the vocal folds. Tumors present as numerous, verrucous outgrowths from the mucosa and can become symptomatic due to mass effect. Common symptoms include hoarseness, dysphonia, aphonia and most concerning, respiratory distress. A 7-year-old patient with dysphonia secondary to laryngeal papillomatosis also known as recurrent respiratory papillomatosis undergoes microlaryngoscopy and bronchoscopy with microdebridement, CO2 laser ablation, and cidofovir injections. Methods: The patient underwent spontaneous ventilation anesthesia and a dental guard was placed. The patient was positioned for microlaryngoscopy and the larynx was visualized and anesthetized with topical lidocaine. A zero-degree Hopkins rods was passed through the supraglottis, glottis and subglottis to document findings. There was supraglottic papillomatosis notably of the laryngeal surface of the left epiglottis, papillomatosis of the bilateral false vocal folds and papillomatosis of the bilateral true vocal folds with right more affected than left and anterior commissure involvement. The scope was then withdrawn and reintroduced to perform bronchoscopy. The scope was advanced through the trachea, carina and primary and secondary bronchi bilaterally. All were within normal limits. The Benjamin-Lindholm laryngoscope was passed into the vallecula and larynx and suspended in a normal fashion. The zero-degree Hopkins rod was used to visualize the larynx. 2 cc of 1% lidocaine with 1:100,000 epinephrine was injected into the bulk of the papillomas and then several biopsies were taken from this area. The microdebrider was used to debulk these areas. Protective eyewear was used by everyone in the operating room. The patient's face was protected with water soaked towels and all oxygen sources were removed from the patient. The CO2 laser was set to 2 watts continuous and used to debulk the papillomas with eschar noted after each application. Care was taken to avoid injury to the deep elements of the true vocal folds. Any residual papillomas at the anterior vocal folds were then injected with 1 cc of cidofovir. All instrumentation was removed, the patient was extubated, awakened, and transferred to the recovery room. Results: The patient was discharged the same day without complications. He will follow up for revision microdebridement, CO2 laser ablation and cidofovir injections. Conclusion: Microlaryngoscopy and bronchoscopy with microdebridement, CO2 laser ablation, and cidofovir injections is a successful solution for laryngeal papillomatosis and has been proven to eradicate the disease in many cases.

Lateral Rectus Plication
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Introduction Muscle plication is a type of strabismus surgery that aims to tighten an extraocular muscle by partially folding the muscle under or over itself without disinsertion. The patient is a 14-year-old with alternating esotropia, who previously had a medial rectus recession. Therefore, she underwent plication of the lateral rectus muscle for this procedure. Methods A conjunctival incision is made in the fornix. Tenon's capsule is dissected to expose the lateral rectus muscle. The lateral rectus muscle is isolated using a Stevens tenotomy hook followed by a Jameson muscle hook. A Stevens tenotomy hook is used to sweep around the muscle to confirm the location of the muscle pole. A caliper is used to mark the predetermined amount of plication, starting at the muscle insertion and marking further posteriorly on the muscle. The muscle is then secured at the location marked by the caliper with a double-armed 6-0 VicrylTM suture with a central bite and double-locking bites at each pole of the muscle. Plication is achieved by bringing the muscle anteriorly and attaching it to the sclera adjacent to the muscle insertion with half-scleral depth bites in crossed-swords fashion. The muscle is tied down to its new location and 6-0 plain gut sutures are used to close the conjunctival incision. Results No complications arose during the procedure. Postoperatively, the patient had subconjunctival hemorrhage, injection, and pain that decreased over the following week. Neomycin-polymyxin-dexamethasone drops were applied daily to prevent infection and inflammation. At the three-month follow up, the redness had resolved. The alternating esotropia had improved. Conclusion Lateral rectus plication is a safe procedure that can effectively treat esotropia. By: Michelle Huynh College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA mhuynh@uams.edu Surgeons: Brita Rook, MD Arkansas Children’s Hospital – Department of Ophthalmology, Little Rock, Arkansas, USA BSRook@uams.edu Joseph Fong, MD Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA JFong@uams.edu Video was performed at Arkansas Children’s Hospital, Little Rock, AR, USA.

Lip Pit Excision
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This video shows a pediatric patient with Van der Woude syndrome. He has lip pits that are classic for this syndrome and his family desired surgical correction. This video outlines and shows the steps of the modified simple excision technique as well as discussing tips for a successful surgery.

Chalazion Incision and Curettage
video

Intro A chalazion is a lipogranulomatous inflammation of a meibomian gland in the eyelid that presents as a painless eyelid nodule or swelling. This pediatric patient presented with a chalazion that caused symptoms of eye irritation. The lesion had persisted for many months without improvement in response to warm compresses and eyelid scrubs with baby shampoo. Therefore, she underwent chalazion incision and curettage under sedation. Methods This video highlights the steps of chalazion incision and curettage. With a chalazion clamp tightened over the lesion, the eyelid is everted and an incision is made into the tarsus. A curette is used to scrape the walls of the cyst to remove the chalazion contents. At the conclusion of the procedure, the clamp is removed and pressure is applied to the area of the lesion for hemostasis. Conclusion Incision and curettage is a safe, relatively quick, and effective procedure for the management of persistent chalazia. Authors Michelle L. Huynh, BA College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA Muhammad Shamim, MD Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA Christian Ponder, MD Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA A. Paula Grigorian, MD Arkansas Children’s Hospital – Department of Ophthalmology, Little Rock, Arkansas, USA The procedure was performed at Arkansas Children’s Hospital, Little Rock, AR, USA. Music by bensound.com.

Tongue Reduction (Partial Glossectomy) for Pediatric Macroglossia
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This video demonstrates how to perform a tongue reduction using a Y-V advancement technique for pediatric macroglossia.

Pre-operative marking for the Fisher technique in unilateral cleft lip repair
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This video outlines the steps taken for pre-operative markings that need to be made prior to performing unilateral cleft lip repair using the Fisher anatomic subunit approximation technique. The technique has been written about in detail by Dr. David Fisher in his article "Unilateral Cleft Lip Repair: An Anatomical Subunit Approximation Technique". This video simply outlines the markings that are made prior to performing this technique, which are crucial for correctly carrying out the repair.

Flash Pulse Dye Laser (595nm) Therapy on Facial Capillary Malformation
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This video teaches its viewers about facial capillary malformations, possible sequelae, as well as a treatment option, flash pulse dye laser. Authors: Maya Merriweather, BS and Richter T. Gresham, MD FACS Email: mmerriweather@uams.edu and GTRichter@uams.edu Institutions: University of Arkansas for Medical Sciences and Arkansas Children's Hospital

Non-fenestrated Extracardiac Fontan
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This video demonstrates a non-fenestrated extracardiac fontan. This is the final step in palliation of hypoplastic left heart syndrome. Authors: Ethan Chernivec; Chris Eisenring, ACNP-BC; Lawrence Greiten, MD; Brian Reemtsen, MD. Arkansas Children's Hospital, Department of Pediatric Cardiothoracic Surgery, Little Rock, AR University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR

Closure of a Large Secundum ASD
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Institution: University of Arkansas for Medical Sciences Authors: Thomas Heye - teheye@uams.edu Lawrence Greiten MD - lgreiten@uams.edu Christian Eisenring ACNP-BC - EisenringC@archildrens.org

Transannual Patch Repair of Tetralogy of Fallot
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Institution: University of Arkansas for Medical Sciences Authors: Thomas Heye - teheye@uams.edu Lawrence Greiten MD - lgreiten@uams.edu Christian Eisenring ACNP-BC -EisenringC@archildrens.org

RV-PA Conduit Replacement in d-TGA
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Replacement of a stenotic/irregular right ventricle to pulmonary artery Gore-Tex trileaflet graft with a novel KONECT RESILIA Aortic Valved Conduit. This is the only tissue valved conduit currently in use. This patient has d-transposition of the great arteries along with ASD, VSD, pulmonary stenosis, bovine left arch and aberrant right subclavian arteries. His previous operations include MBTS 4mm Gore-Tex graft, urgent shunt revision secondary to thrombosis and subsequent conversion to a 4mm central shunt, right atrial thrombectomy secondary to indwelling right atrial catheter, takedown of central shunt, primary pledgeted closure of pulmonary valve, Gore-Tex patch closure of ASD/VSD, Rastelli procedure with 24mm Gore-Tex trileaflet with bulging sinuses graft.

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Introducing our presenters for the upcoming Cleft Lip Revision webinar!
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This webinar comes as the latest in a long line of installments dealing with the Cleft Palate. In this session, attendees will learn various tips and tricks to a successful cleft lip revision procedure. There will be a Q&A session to discuss common challenges and how to address them.

Meet the Course Directors

Dr. Larry Hartzell
Dr. Steven Goudy

Director of Cleft Lip and Palate / Pediatric ENT Surgeon

Arkansas Children's Hospital / University of Arkansas for Medical Sciences

Larry Hartzell, MD FAAP is an Associate Professor of Otolaryngology Head and Neck Surgery at Arkansas Children’s Hospital. He is the Director of the Pediatric Otolaryngology fellowship. Dr Hartzell also has been the Cleft Team Director in Arkansas since 2012. He is passionate about international humanitarian mission work and dedicates much of his research efforts to cleft surgical and clinical care as well as velopharyngeal insufficiency. Dr Hartzell is actively involved in multiple academic societies and organizations including the AAO-HNS and ACPA.

Professor / Director of Division of Otolaryngology

Emory University School of Medicine / Children's Healthcare in Atlanta

Dr. Goudy is a professor at Emory University School of Medicine and the director of the division of otolaryngology at Children’s Healthcare in Atlanta. Dr. Goudy’s clinical job involves repair of craniofacial malformations including cleft lip, cleft palate, and Pierre Robin sequence, and he also participates in head and neck tumor resection and reconstruction.


Meet the Presenters

Lauren K. Leeper, MD, FACS
Ashley E. Manlove DMD, MD, FACS

Associate Professor of Department of Otolaryngology--Head & Neck Surgery, Division of Pediatric Otolaryngology

University of North Carolina - Chapel Hill

Dr. Leeper completed her residency training in Otolaryngology--Head & Neck Surgery at the Medical University of South Carolina in 2012 and fellowship training in Pediatric Otolaryngology at Arkansas Children's Hospital in 2014. She returned to the University of North Carolina - Chapel Hill in 2014 on faculty in the Department of Otolaryngology--Head & Neck Surgery. She is the current Fellowship Director and Medical Director of the Children's Cochlear Implant Center. She is married to Bradley and they have one daughter Sutton and a baby boy arriving this month.

Residency Program Director / Director Cleft and Craniofacial Team

Carle Foundation Hospital

Dr. Manlove joined Carle Foundation Hospital in 2016 as a fellowship trained cleft and craniomaxillofacial surgeon. She is the director of the cleft and craniofacial team at Carle. In 2018 she was name “Rising Star Physician” and that same year she also became the residency program director. Outside of work, she loves spending time with her family and she is an avid runner.

Deborah S. F. Kacmarynski, MD, MS
Jordan Swanson, MD, MSc

Associate Professor - Craniofacial Abnormalities & Pediatric Otolaryngology / Co-Director of Cleft and Craniofacial Team

University of Iowa Hospitals & Clinics

Dr. Kacmarynski is a Clinical Associate Professor in the Department of Otolaryngology-Head & Neck Surgery at the University of Iowa, working as a pediatric otolaryngologist and a cleft and craniofacial surgeon with co-directorship for the cleft and craniofacial team at the University of Iowa. Research focus is on biomedical collaborations with oral cleft and craniofacial surgical problems including craniofacial airway, tissue engineering solution development, outcomes research and patient-centered outcomes research collaboratives. I am excited about the long-term impacts of research leading very directly to significant improvements in o

Linton Whitaker Endowed Chair in Craniofacial Surgery

Children’s Hospital of Philadelphia, Division of Plastic Surgery

Jordan Swanson, MD, MSc, is an attending surgeon in the Division of Plastic, Reconstructive and Oral Surgery at Children’s Hospital of Philadelphia with special clinical expertise in cleft, craniofacial, and pediatric plastic surgery. He holds the Linton A. Whitaker Endowed Chair in Plastic, Reconstructive and Oral Surgery.

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