Laryngomalacia is the most common laryngeal anomaly affecting newborns. Patient's with severe disease should be considered for supraglottoplasty. It classically presents in a newborn with high-pitched inspiratory stridor that worsens with exertion, supine-positioning, and feeding. It is characterized by anatomic and physiologic abnormalities including shortened aryepiglottic (AE) folds, small, tightly curled epiglottis, redundant soft tissue overlying the cuneiform or accessory cartilages and reduced laryngeal tone. Any combination of these may present with laryngomalacia. Most cases are mild and resolve with observation or medical therapy. Steps: 1. Laser precautions are taken to protect patient and personnel. 2. Spontaneous ventilation 3. Suspension laryngoscopy is performed with adequate visualization of the larynx. 4. The operating telescope or microscope is used for visualization. The CO2 laser is tested. 5. First, division of the AE folds is performed. 6. Next, redundant mucosa and tissue overlying the accessory cartilages is ablated.
Double Stage Laryngotracheal Reconstruction with Anterior and Posterior Rib Cartilage Graft.
The procedure shown in this video is an awake transcervical injection laryngoplasty via a thyrohyoid membrane approach. Editor Recruited By: Michael M. Johns III, MD DOI: http://dx.doi.org/10.17797/elckgrc4zg
The procedure shown in this video is a pediatric ansa to recurrent laryngeal nerve reinnervation. It is performed with a concurrent laryngeal electromyography and injection laryngoplasty. Editor Recruited By: Sanjay Parikh, MD, FACS DOI: http://dx.doi.org/10.17797/7jjbn56ca3
Contributor: Tyler McElwee Choanal atresia describes the congenital narrowing of the back of the nasal cavity that causes difficulty breathing in neonate. Choanal atresia is often associated with CHARGE, Treacher Collins and Tessier Syndrome. It is a rare condition that occurs in 1:7000 live births, seen in females twice as often as males, and affects bilaterally in roughly 50% of cases. Bilateral choanal atresia is usually repaired in the newborn period. Unilateral CA repair is often deferred until age 2-3 years. Stent placement has become optional as stentless repair is gaining popularity because this technique decreases foreign body reaction in the nasopharynx which in term decreases granulation formation. Transnasal endoscopic choanal atresia repair is performed by opening the atresia bilaterally, drilling out pterygoid bone as needed, and removal of the posterior septum and vomer. Normal mucosa is preserved as much as possible by elevating a lateral based mucosal flap to prevent scarring and restenosis. Postoperatively, these patients are treated with antibiotic, reflux medications and steroid nasal drops; a second look procedure is planned 4-6 weeks postop for debridement and possible removal of granulation tissue & scar. DOI: http://dx.doi.org/10.17797/9s5ty2f7yv Editor Recruited By: Sanjay Parikh, MD, FACS
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
Contributors: Deepak Mehta This video depicts how to harvest a rib cartilage graft for use in pediatric laryngotracheal reconstruction for airway stenosis. DOI# http://dx.doi.org/10.17797/oo77838cxt Authors Recruited By: Deepak Metha
In this video, we demonstrate the set-up, port configuration, and key steps involved in performing a robotic-assisted retroperitoneoscopic partial nephrectomy. DOI#: https://doi.org/10.17797/di559dgayo
History of airway stenosis, s/p laryngotracheal reconstruction. Developed restenosis, and balloon dilated three times.
In this video we describe our technique for airway stent insertion and its securing to the neck skin.
Balloon dilation of the airway expanded the airway to its appropriate size. After sizing, an 8mm modified Mehta laryngeal stent with rings (Hood Laboratories, Pembroke, Mass., USA)is inserted in the airway with laryngeal forceps. The scope is inserted into the stent to verify its position. Then a 2.0 prolene stitch is taken through the neck, trachea, stent, and taken out through the contralateral skin. This is performed under visualization with a 2.3mm endoscope through the stent. The needle is then re-inserted through the exit puncture and again taken out next to the entry puncture after passing through a subcutaneous tunnel, without re-entering the stent. A small skin incision is performed between the two prolene threads. Multiple knots are taken over an angiocath, which is then buried under the skin.
The stent is taken out 2-6 weeks after the procedure. A neck incision is performed, the angiocath is identified, the knot is cut and the stent is removed under the vision of the endoscope.
Chronic tympanic membrane (TM) atelectasis is a difficult condition with many management challenges and currently has no acceptable gold standard treatment. TM atelectasis is the loss of the normal elasticity of the TM as a result of chronic negative pressure in the middle ear and can be associated with retraction pockets. The under-ventilation of the middle ear and TM retraction can cause ossicular erosion, hearing loss, or cholesteatoma formation. Atelectasis can be halted or reversed with placement of pressure equalization tube (PET). Cartilage tympanoplasty with or without PET has been reported as the preferred material likely due to its higher mechanical stability under negative pressure changes within the middle ear, in addition to its resistance to resorption. This video demonstrates the feasibility of a minimally invasive endoscopic approach of cartilage shield T-tube tympanoplasty as a treatment of chronic TM atelectasis.
We present the case of a 20 months old boy with developmental delay and chromosomal abnormality, who presented with a history of chronic aspiration. He was found to have a laryngeal cleft, which was injected with Prolaryn, then formally repaired, twice. Despite an initial a negative swallow study, the patient had persistent aspiration. A repeat direct laryngoscopy and bronchoscopy finally revealed the presence of an H-type tracheoesophageal fistula (TEF). We describe here the steps of the surgical repair of an H-type tracheoesophageal fistula.
The video demonstrates successful endoscopic coblation of lingual tonsils and residual palatine tonsils as well as successful TORS reduction of obstructive base of tongue tissue.
The Osia System is a transcutaneous bone anchored hearing aid which can be used for the correction of both conductive and sensorineural hearing loss. This video depicts the implantation of the Osia in a pediatric patient with a history of right-sided microtia.
Congenital aural atresia (CAA) is a birth defect that describes both aplasia and hypoplasia or stenosis of the external auditory canal (EAC). CAA can be associated with microtia (malformation of the pinna), middle ear and occasionally inner ear malformations. Surgical correction of CAA is a very challenging operation and requires a thorough knowledge of the surgical anatomy of the facial nerve, middle and inner ears. Traditional post-auricular approach or transcanal approach with the help of a microscope usually provides adequate images needed for the procedure. Endosocpic ear surgery provides the advantage of visualization beyond the view provided by the microscope, further refinement of the surgical approach, precise assessment of the ossicular chain mobility and placement of ossicular chain prosthesis if necessary.
In the second installation of CSurgeries’ series in otology, join this interactive webinar with Dr. Sharon Cushing, paediatric otolaryngologist at The Hospital for Sick Children in Toronto, Canada, and an Associate Professor and Clinician Investigator in the Department of Otolaryngology Head and Neck Surgery at the University of Toronto, Dr. Samantha Anne, faculty member and otolaryngologist at the Cleveland Clinic, and Dr. Rodrigo C. Silva, Director, Ear and Hearing Center, Texas Children’s Hospital and Associate Professor, Baylor College of Medicine. This panel of experts will discuss how Cochlear implantation (CI) has evolved into the standard of care for the rehabilitation of children with significant hearing loss. These faculty members will discuss videos showcasing the most current techniques for CI in children, as well as pearls and strategies to avoid complications.
In the first installation of CSurgeries’ series on laryngology, join this interactive webinar with Dr. Julina Ongkasuwan, associate professor of adult and pediatric laryngology at Baylor College of Medicine, and Dr. Vyvy Young, associate professor and the associate residency program director of otolaryngology-head and neck Surgery at the University of California – San Francisco, as they walk us through a videos on an awake vocal fold injection procedure. Drs Ongkasuwan and Young will share this video and will provide detailed commentary on their approach.
Battle of the Medialization Techniques: Michael “Type 1 Thyroplasty” Johns vs. Julina “Reinnervation” Ongkasuwanwebinar
In the next installation of CSurgeries’ series on laryngology, join this interactive webinar with Dr. Julina Ongkasuwan, associate professor of adult and pediatric laryngology at Baylor College of Medicine, and Dr. Michael Johns, Director, USC Voice Center and Professor, Caruso Department of Otolaryngology – Head and Neck Surgery – University of Southern California, for a discussion of permanent medialization techniques. Type 1 thyroplasty vs Reinnervation.
Which one will you choose and when?
- Professor and Vice Chair
- Department of Head and Neck Surgery
Ehab Hanna, M.D., FACS, is an internationally recognized head and neck surgeon and expert in the treatment of patients with skull base tumors and head and neck cancer. He is Professor and Vice Chair of the Department of Head and Neck Surgery at The University of Texas MD Anderson Cancer Center in Houston, Texas. After earning his medical degree, he completed a surgery internship at Vanderbilt University, and residency in Otolaryngology-Head and Neck Surgery at The Cleveland Clinic in Cleveland, Ohio. He received advanced fellowship training in skull base surgery and head and neck surgical oncology at the University of Pittsburgh Medical Center. He joined the MD Anderson faculty in 2004 with a joint appointment at Baylor College of Medicine. He is the medical director of the Multidisciplinary Head and Neck Center and co- director of the Skull Base Tumor program at MD Anderson. Dr. Hanna recently served as President of the North American Skull Base Society (NASBS) which was founded in 1989, and is a professional medical society that facilitates communication worldwide between individuals pursuing clinical and research excellence in skull base surgery. Dr. Hanna is leading the development of minimally invasive and robotic applications in skull base surgery. He has consistently been named one of America’s Top Doctors by the Castle Connolly Guide. In addition to patient care, Dr. Hanna is actively engaged in clinical and translational research with emphasis on skull base tumors. He is the Editor-in-Chief of the journal of Head & Neck, which is the official journal of the International Federation of Head and Neck Societies. He also co-edited a text book on “Comprehensive Management of Skull Base Tumors”.
- Department of Interventional Radiology
Dr. Desai earned his Doctorate of Medicine with Distinction in Research and Alpha Omega Alpha honors from Albany Medical College, after completing the six-year BS/MD program in conjunction with Rensselaer Polytechnic Institute. During his latter years of medical school, he was selected as a scholar of the Clinical Research Training Program at the National Cancer Institute of the National Institutes of Health, a clinical fellowship geared towards the development of translational researchers. He then went on to residency at Stanford University (General Surgery) and UCSF (Diagnostic Radiology), followed by fellowship in Vascular and Interventional Radiology at Northwestern University. He was a private practice adult Interventional and Diagnostic Radiologist for ten years. In July 2016, he returned to fellowship for an advanced training year with a focus on Pediatric Interventional Radiology, at Children’s Hospital of Boston. Subsequently, he joined Baylor College of Medicine (Houston, TX), on the staff at Texas Children’s Hospital. He currently provides interventional care to adult and pediatric patients.
In his time outside of the clinic, he serves as a consultant to multiple established and start-up medical companies (TVA Medical, Exit BD/Bard 2018), Scientific Advisor to Santé Ventures (Austin, TX) and Chief Editor for Interventional Radiology CSurgeries.com. Previously he was an invited advisor to the Rice University Jones School of Business (Technology Entrepreneurship). He was a member of the Advisory Council for the Masters in Clinical Translation Management at the St. Thomas (Houston, TX) University Cameron School of Business as well. He has been appointed to multiple committees for the Society of Interventional Radiology and has lectured at multiple SIR annual meetings. He is the Chief Editor for IR Quarterly, a distribution of the SIR.
As Past-President/Founder of the Houston chapter of the Society of Physician Entrepreneurs, and a Member of the SoPE International Board of Directors, Dr. Desai works to engage physicians interested in innovation and idea development, as well as to provide mechanisms and insights to assist early-stage companies in tackling the many challenges to successful exits.
- Director, Pediatric Aerodigestive Center – Texas Children’s Hospital
- Professor of Otorhinolaryngology – Baylor College of Medicine
Dr. Mehta’s clinical interests are complex airway surgery, pediatric swallowing disorders and head and neck masses,along with general otolaryngology. His research interest includes outcomes of airway surgery, laryngeal cleft management and outcomes of sleep disorders.
Dr Gitta Madani, FRCR, MRCS, MBBS, FDSRCS, BDS
Consultant Radiologist and Honorary Senior Lecturer
Imperial College Healthcare NHS Trust and Imperial College London
Gitta Madani is a Consultant Radiologist with a specialist interest in all aspects of head and neck and skull base radiology and performs image-guided procedures in the head and neck. She is an Honorary Lecturer at Imperial College London and involved in research, training and teaching. She has authored several book chapters, various peer-reviewed articles and national imaging guidelines.
Ali Zul Jiwani, MD, MSc, DAABIP
Director of Interventional Pulmonology
Orlando Health Cancer Institute
Dr. Jiwani, is a board-certified interventional pulmonologist with the Rod Taylor Thoracic Care Center at Orlando Health Cancer Institute where he also leads the institute’s lung cancer screening program. As an interventional pulmonologist he specializes in minimally invasive diagnostic and therapeutic endoscopy and other procedures to treat malignant and benign conditions of the airway, lungs and thorax plus pleural diseases.
David E. Rosow, MD, FACS
Director, Division of Laryngology and Voice / Associate Professor, Dept. of Otolaryngology
University of Miami Miller School of Medicine
Dr. Rosow is Associate Professor of Otolaryngology at the University of Miami Miller School of Medicine, where he has led the Division of Laryngology and Voice for over 10 years. His research and clinical interests include laryngeal cancer, recurrent respiratory papillomatosis, vocal fold paralysis, laryngotracheal stenosis and airway reconstruction, and spasmodic dysphonia. In addition to scientific publications in these areas, he has also written and edited a textbook on evidence-based practice in Laryngology.
Professor Stephen R Durham MD FRCP
Professor of Allergy and Respiratory Medicinec
National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital London
Professor Durham is Head of Allergy and Clinical Immunology at NHLI and has run a joint Nose Clinic with Professor Hesham Saleh for many years. His research interests include allergic rhinitis, asthma and translational studies in allergen immunotherapy. He is a member of the Steering Committee, Immune Tolerance Network, National Institutes of Allergy and Infectious Diseases, NIH, USA.
Professor Jane Setterfield
Professor of Oral & Dermatological Medicine
Guy's & St Thomas Hospital & King's College London
Jane Setterfield is Professor of Oral and Dermatological Medicine at King’s College London and Consultant in Dermatology at St John’s Institute of Dermatology, Guy’s & St Thomas Hospitals. She leads the Oral Dermatology Service both at St John’s Institute and the Department Oral Medicine Guy’s Dental Institute. Her areas of clinical interest include immunobullous diseases, lichenoid disorders vulval dermatoses and mucocutaneous diseases. Her research areas include diagnostic techniques, pathogenic mechanisms, clinical outcome measures and optimising therapeutic approaches for mucocutaneous diseases.
Laura Matrka, MD
Ohio State University Wexner Medical Center Department of Otolaryngology - Head and Neck Surgery
Laura Matrka, MD, is an Associate Professor at the Ohio State University Wexner Medical Department of Otolaryngology – Head & Neck Surgery. She graduated magna cum laude from Dartmouth College with a BA in English and concentrations in Anthropology and Spanish, completed medical school at University of Cincinnati College of Medicine, completed her residency in Otolaryngology at The Ohio State University, and completed a Laryngology fellowship at the University of Texas Health Sciences Center, San Antonio. She is a full-time clinician who devotes significant additional time to clinical research, focusing on complicated airway management, tracheostomy complications, dysphagia after anterior cervical spine surgery, recurrent respiratory papillomatosis, gender-affirming health care, and opioid-related research, among other topics. She was inducted into the American Laryngologic Association in 2020, the Triological Society in 2019, and the American Bronchoesophageal Association in 2015.
Alexander Gelbard, MD
Vanderbilt Center for Complex Airway Reconstruction (AeroVU)
Dr. Gelbard is a board certified Otolaryngologist at Vanderbilt University in Nashville Tennessee specializing in adult laryngeal and tracheal disease. He completed his undergraduate education at Stanford University, medical school at Tulane School of Medicine, and internship and residency at the Baylor College of Medicine in Houston Texas. Dr. Gelbard completed a postdoctoral research fellowship in Immunology at the MD Anderson Cancer Center as well as a clinical fellowship in Laryngeal Surgery at Vanderbilt School of Medicine. He has authored numerous peer-reviewed articles and book chapters and lectures internationally on adult airway disease. He currently is Co-director of the Vanderbilt Center for Complex Airway Reconstruction (AeroVU). Additionally, he is a NIH-funded principle investigator studying the immunologic mechanisms underlying benign laryngeal and tracheal disease. He is also PI of an externally funded prospective multi-institutional study of idiopathic subglottic stenosis (iSGS) and managing director of the North American Airway Collaborative (NoAAC). NoAAC is a funded, multi-institutional consortium with 40 participating centers in the United States and Europe that works to exchange information concerning the treatment of adult airway disease. It is composed of outstanding collaborators who pursue a unique combination of genetic, molecular, and epidemiologic based approaches to investigate the critical factors underlying the pathogenesis and outcomes of laryngotracheal stenosis.
Taner Yilmaz, MD
Professor of Otolaryngology-Head & Neck Surgery
Hacettepe University Faculty of Medicine, Ankara, Turkey
Dr. Yilmaz has worked in laryngology since 2000. He is a member of ELS, ALA and IAP, publishing 94 international manuscripts which received 1100 citations. On top of those achieveiments, he also has two patents for a laryngoscope for arytenoidectomies and an epiglottis holding forceps for grasping a floppy epiglottis that folds inside the larynx during larygoscopy.
Edward J. Damrose, MD, FACS
Professor of Otolaryngology-Head & Neck Surgery
Stanford University School of Medicine
Dr. Damrose is Professor of Otolaryngology/Head and Neck Surgery and (by courtesy) of Anesthesiology, Perioperative & Pain Medicine in the Stanford University School of Medicine. He is the founding Chief of the Division of Laryngology and Program Director of the Stanford Fellowship in Laryngology & Laryngeal Surgery. He is member of the American Laryngological Association as well as the Triological Society, and has authored or coauthored more than 80 peer reviewed publications and 16 book chapters.
Kate Heathcote, MBBS, FRCS
University Hospitals Dorset
Kate Heathcote established the Robert White Centre for Airway, Voice and Swallow to provide a comprehensive diagnostic and treatment service. She has lectured and trained surgeons nationally and internationally in cutting edge laryngology techniques.
Phillip Song, MD
Division Director in Laryngology
Imperial College LonMassachusetts Eye and Ear Infirmary
Dr Song is the Division Director of Laryngology at Massachusetts Eye and Ear Infirmary and Assistant Professor of Otolaryngology and Head and Neck Surgery at Harvard Medical School. He specializes in laryngology with a special interest in neurolaryngology and central airway disease.
Brianna Crawley, MD
Associate Professor, Co-Director
Loma Linda University Voice and Swallowing Center
Dr. Crawley is a board-certified otolaryngologist and member of the Academy of Otolaryngology- Head and Neck Surgery, the ABEA, and the post-grad ALA. Her interests include neurolaryngology, swallowing disorders, performing voice and the surgical airway. She continues to work in new fields of research focusing on presbylarynx and presbyphonia, neurolaryngology, and understanding the patient experience.
Ramon Franco Jr, MD
Medical Director, Voice and Speech Lab, Senior Laryngologist
Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston MA, USA
Dr. Ramon Franco is a board-certified laryngologist who specializes in voice, swallowing, and breathing disorders. His main areas of expertise are in the diagnosis and treatment of voice disorders, airway stenosis, laryngeal cancer, and neurological disorders affecting the voice box. He also has special interests in the medical and surgical care of the professional voice. He serves as an Executive Board Member for the Massachusetts Society of Otolaryngology and is a fellow for the Triological Society and the American Laryngological Association.
Clark A. Rosen, MD
Co-Director / Chief - Division of Laryngology
UCSF Voice and Swallowing Center
Clark Rosen, MD is a Co-Director of the UCSF Voice and Swallowing Center, Chief of the Division of Laryngology, Professor of Otolaryngology-Head and Neck Surgery and the F Lewis Morrison MD Endowed chair of Laryngology. Dr. Rosen inaugurated modern laryngology at the University of Pittsburgh beginning in 1995 creating a dedicated center of excellence in Laryngology: University of Pittsburgh Voice Center. Dr. Rosen originated the outstanding Fellowship in Laryngology and Care of the Professional Voice at the University of Pittsburgh in 2002 and trained over 15 fellows in Larynogology and numerous visiting Otolaryngologists until 2018. He is now the director of the Laryngology fellowship at the UCSF Voice and Swallowing Center. Dr. Rosen has been a sought after speaker internationally and has had major service to multiple publications and professional societies. He is a founding member of the Fall Voice Conference, was the Vice Chair of the Annual Meeting Program Committee for the American Academy of Otolaryngology-Head and Neck Surgery (AAOHNS), and was the Treasurer of the American Laryngological Association (ALA) and is now president of the ALA.
The 2022 International Pediatric Airway Symposium is coming up in two weeks! It's time to meet the people responsible for pulling together such an amazing group of surgeons: Our Course Directors!
Catherine Hart, MD
Associate Professor, Department of Otolaryngology - Head & Neck Surgery
Cincinnati Children’s Hospital Medical Center
Dr. Catherine Hart received her medical degree from the University of Minnesota Medical School, followed by a residency at University of Cincinnati Medical Center and a fellowship at Cincinnati Children’s Hospital Medical Center. Today she is affiliated with the Cincinnati Children’s Hospital Medical Center. Her areas of research focus on better understanding of surgical management of airway stenosis and improving safety in tracheostomy tube-dependent children.
Joshua Bedwell, MD
Associate Professor of Pediatric Otolaryngology
Baylor College of Medicine / Texas Children’s Hospital
Dr. Joshua R. Bedwell is an ENT-Otolaryngologist located in Houston, Texas. He received his medical degree and completed his residency from the Icahn School of Medicine at Mount Sinai. He later performed a fellowship at the Children’s National Medical Center. He is currently affiliated with Texas Children’s Hospital. Dr. Bedwell is active in clinical and translational research, and collaborates with colleagues at home and around the world in efforts to improve medical education, quality of care, and patient outcomes.
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