Intraoperative Injection of Methylene Blue Dyed Fibrin Glue For 2nd Branchial Cleft Fistula Excisionvideo
The following video depicts the excision of a 2nd branchial cleft fistula in a 12-month-old male. Fibrin glue dyed with methylene blue was used to assist with following the fistula tract to ensure complete excision of the lesion. Branchial cleft anomalies include fistulae, sinuses and cysts and most commonly occur in the lateral neck arising from the second branchial cleft. The patient may be completely asymptomatic, mildly affected or continuously impacted by the lesion. Recurrent inflammation, infections, drainage, and pain are common symptoms associated with these congenital anomalies. Surgery is the standard of care and recommended to alleviate symptoms, but recurrence rates are high, particularly if excision is incomplete. Methylene blue has been used to assist with complete excision of these lesions, but has several key drawbacks including spillage into nearby tissues, incompletely highlighting the lesion, and making the pathological examination more challenging due to significant tissue staining. The addition of fibrin glue to the methylene blue enables for the lesion to be well visualized with the dye without spilling into the adjacent tissue, and thereby reducing the risk of damaging nearby structures. The mixture also allows for efficient pathological examination for correct post-operative confirmation of the diagnosis.
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.
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.
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.
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.
Upgrade your membership to continue watching
Please upgrade to membership to continue watching more videos.Upgrade Now
Renew your subscription to continue watching
Please renew your subscription to continue watching.Renew Now