Pediatric Tracheostomy

Paediatric Tracheostomy Position the child with chin extension appropriately Drape the child as shown in the video Mark the incision line Use 15 number blade for skin incision Remove the excessive subcutaneous fat tissue Find the median raphe and strap muscles Retract the strap muscles laterally Identify the tracheal ring Create the impression of tube for appropriate size incision Place the stay sutures as shown in the video incise the trachea with 11 number blade Secure the maturation sutures Insert the tracheostomy tube Confirm the position and then inflate the cuff Secure the ties and dressing at the end.

Tension-free thyroidectomy (TFT)

In this video, we present a new method of tension-free thyroidectomy (TFT). The procedure is based on the medial approach to the recurrent laryngeal nerve and the parathyroid glands after the division of isthmus and successive complete dissection of Berry's ligament. The operation was performed under general anesthesia with endotracheal intubation. Patients were placed in a supine position without neck extension. A 35-40 mm horizontal skin incision was made 1 cm above the sternal notch. Subcutaneous fat and platysma muscle were dissected. The linea alba was incised longitudinally for 4–5 cm. When the isthmus capsule was exposed, the last was divided in the middle. Full mobilization of the isthmus and thyroid lobe from the trachea by dissecting the Berry's ligament was performed. Intermitted neuromonitoring (5 mA, Inomed C2) was used to guide the division of fibers of the Berry's ligament. By using the pinnate the thyroid lobe was retracted into the lateral direction (only lateral traction of the thyroid lobe was used during the operation). The mobilization of the thyroid lobe from the trachea was completed by the division of small branches of the inferior thyroid artery and vein. The main branch of the inferior thyroid artery and vein were preserved along with the vessels supplying the parathyroid glands. After complete separation of the thyroid lobe and inferior thyroid vessels from the trachea the recurrent laryngeal nerve was identified and dissected. Also from the medial side, the upper and lower parathyroid glands and their vessels were identified and fully separated from the thyroid capsule. The lower pole of the lobe was pulled out of the thyroid bed. Finally, after neuromonitoring of the superior laryngeal nerve, the upper pole vessels were dissected and divided. In case a total thyroidectomy the same procedure was performed on the contralateral side after vagus stimulation (V2).

Rectus Abdominis Myocutaneous Flap Harvest

This video highlights the surgical nuances of rectus abdominis myocutaneous free flap harvest.

Grace Medical Bojrab ALTO

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Grace Medical ALTO System

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Hypoglossal Nerve Stimulator Implantation: 2-Incision Technique

Hypoglossal Nerve Stimulator Implantation: 2-Incision Technique Authors: Cheryl Yu, MD1; Nilan Vaghjiani, BS1; Ryan Nord, MD1 1Virginia Commonwealth University School of Medicine, Department of Otolaryngology/ Head and Neck Surgery, Richmond, VA 

Background: 

Obstructive sleep apnea is a worldwide health problem that affects all groups. Given its systemic associations with comorbid diseases, it ultimately increases lifetime risk of mortality and thus, should not be a disorder taken lightly. Although continuous positive airway pressure is thoroughly acknowledged as the gold standard for treating OSA with studied efficacy, adherence remains challenge. Given such, hypoglossal nerve stimulation therapy presents a revolutionary alternative for those with moderate to severe degrees of OSA who are unable to tolerate standard CPAP therapy. It has been studied to be very efficacious in treating the disorder, with reductions in apneas up to 70-80%. The surgery itself is less invasive, now even more so with the 2-incision technique, when compared to other surgical options such as mandibular advancement or other upper airway surgery, with decreased post-operative pain and healing times. Adherence to therapy is generally superior as the majority prefer it over traditional positive airway pressure therapy.  Overall, hypoglossal nerve stimulator implantation is an effective, tolerable long-term alternative treatment option for those with OSA. 

Case Overview: 84-year-old female with BMI of 31 with past medical history significant for hypertension, atrial fibrillation, and obstructive sleep apnea and inability to tolerate CPAP. Polysomnography revealed severe OSA with an AHI of 33 and minimal central or mixed apneas. Preoperative drug induced sleep endoscopy was performed noting complete anterior-posterior collapse of the velum, no collapse at the oropharynx, complete anterior-posterior collapse of the tongue base, and no collapse at the epiglottis. Patient was subsequently deemed an appropriate candidate for hypoglossal nerve stimulator implantation and elected to proceed with the procedure. The following video demonstrates her hypoglossal nerve stimulator implantation via the 2-incision technique detailing the procedure's anatomic landmarks and corresponding steps.

Minimally Invasive Radioguided Parathyroidectomy

Minimally Invasive Radioguided Parathyroidectomy Author: Joshua Hagood Performing surgeon/coauthor: Brendan C. Stack, Jr., M.D., FACS, FACE Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA Overview: Primary hyperparathyroidism is a disease caused by overproduction of parathyroid hormone (PTH). This condition is most commonly caused by a solitary, hyperfunctioning, adenoma among one of the four parathyroid glands. The hallmark finding of hyperparathyroidism is hypercalcemia which can manifest symptomatically as nephrolithiasis, diabetes insipidus, renal insufficiency, bone pathology, gastrointestinal symptoms, and neuropsychiatric disturbances (remembered as “Stones, Bones, Groans, and Psychiatric overtones”). Minimally invasive Radio guided Parathyroidectomy (MIRP) is a curative procedure for primary hyperparathyroidism that can use both radionuclide guidance and intraoperative PTH measurements to confirm the removal of the offending adenoma. Radionuclide guidance is performed via the injection of 99mTc-sestamibi, which is a radiomarker that sequesters within adenomatous/hypermetabolic parathyroid tissue. Intraoperatively, the amount of 99mTc-sestamibi within excised tissue can be measured with the use of a handheld gamma probe. Instrumentation: -Endotracheal Nerve Integrity Monitoring System (NIMS) -Gamma Probe -Intraoperative PTH assay equipment

Endoscopic Anterior Cricoid Split with Balloon Dilation for Failed Extubation

This is done in infants who have had failed extubation and had maximal medical treatment(steroids,epinephrine etc). This procedure done with careful patient selection will help avoid tracheostomy. The Larynx is suspended using a Lindholm Laryngoscope with patient spontaneously breathing with ventilating through the side port. The airway is first completely assessed to make sure there is no other lesion to explain the failure. The larynx is then suspended with a laryngoscope(Lindholm). With direct visualization a micro laryngeal sickle knife is used to divide the anterior cricoid with palpation of the neck from outside to feel the cut being made. Care is taken not to injure the anterior commissure. Once this is achieved a 5-7 mm balloon is used in an infant to dilate the sub glottis for 30-60 seconds. The patient is either extubated on the table or in a day.Further 24 hrs of steroids is given. For further reading: Laryngoscope. 2012 Jan;122(1):216-9. http://dx.doi.org/10.1002/lary.22155. Epub 2011 Nov 17. Endoscopic anterior cricoid split with balloon dilation in infants with failed extubation. Horn DL, Maguire RC, Simons JP, Mehta DK. DOI: http://dx.doi.org/10.17797/1y99qiqe93

Endoscopic Transcanal Transpromontorial Removal of an Intracochlear Schwannoma and Traditional Cochlear Implantation

Vestibular schwannomas (acoustic neuromas) develop due to mutations in Schwann cells that cause uncontrolled cell division. As a result, a tumor forms. As these tumors grow, they can compress the cochlear nerve causing unilateral hearing loss and tinnitus. Vestibular schwannomas may cause imbalance and occasionally vertigo. Intralabyrinthine schwannomas account for about 10% of vestibular schwannomas in centers that specialize in temporal bone imaging. Intracochlear schwannomas are the most common type of intralabyrinthine schwannomas. In this video, we describe an endoscopic transcanal transpromontorial approach to intracochlear schwannoma removal. This surgery was performed by James Prueter, DO, of Southwest Ohio ENT Specialists in Dayton, OH. Video editing was performed by Austin Miller, OMS-II, Ohio University Heritage College of Osteopathic Medicine.

Nasal Encephalocele: Endoscopic Surgery

Contributors: Vincent Couloigner We describe the excision of a nasal encephalocele obstructing the left nasal fossa with an anterior subcutaneous portion deforming the nasal pyramid in a four-year-old girl using endoscopic surgery combined to a Rethi approach. The anterior skull base defect was reconstructed using autologous conchal cartilage and temporal fascia. Editor Recruited By: Sanjay Parikh, MD, FACS DOI: http://dx.doi.org/10.17797/udewjr2ge7

Microdebrider Assisted Lingual Tonsillectomy

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.

Laser Supraglottoplasty

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.

Excision of Scalp Congenital Hemangioma

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

Endoscopic Tympanoplasty

Transcanal endoscopic tympanoplasty is illustrated with steps explained. This is a "realistic" case with bleeding and middle ear adhesions; tips to overcome these hurdles are discussed. DOI# http://dx.doi.org/10.17797/atpw43so2e Editor Recruited by: Ravi N. Samy

Endoscopic endonasal approach for odontoidectomy

Contributors: M. Nathan Nair and Timothy Deklotz For patients with basilar invagination, an odontoidectomy may be necessary to decompress the brainstem, before further correction and stabilization of the craniocervical junction can be achieved. The open-mouth odontoidectomy procedure is associated with significant moribdity, and the endoscopic endonasal approach may be a better option. In this video, we provide a step-by-step demonstration of the endoscpic endonasal approach for odontoidectomy. DOI:http://dx.doi.org/10.17797/6mx9qe789f

Double Stage Laryngotracheal Reconstruction with Anterior and Posterior Rib Graft

Double Stage Laryngotracheal Reconstruction with Anterior and Posterior Rib Cartilage Graft.

Vocal Fold Cordectomy Type I (ELS classification) for Carcinoma In Situ of the Vocal Fold Using Carbon Dioxide Laser

Authors: Yonatan Lahav, MD, Doron Halperin, MD, Hagit Shoffel-Havakuk, MD. Subepithelial vocal fold cordectomy (Type I cordectomy according to the ELS classification) for Carcinoma In Situ, performed under general anesthesia with direct microlaryngoscopy and suspension using a free beam CO2 Laser. The resection respects the layered structure of the vocal folds and preserves the superficial lamina propria and its vasculature. The video follows the procedure step by step and includes detailed instructions.

Endoscopic Repair of Tracheal-bronchial Sinus Tract

Contributor: Deepak Mehta (Children's Hospital of Pittsburgh) Endoscopic Repair of Tracheal-bronchial Sinus Tract: Clinical History: 6 year-old female with a history of tracheal-esophageal fistula s/p repair at birth and a right sided aortic arch. She has a recent history of 6 episodes of pneumonia requiring hospitalization. She had a normal modified barium swallow exam. CT chest revealed a tract arising from the posterior carina. Operative Course: The patient was taken to the OR and using a 5.0 rigid ventilating bronchoscope we are able to easily visualize the tracheal bronchial sinus tract originating from the posterior carina. A flexible suction catheter was used to probe the tract. It extended approximately 1.5cm. Then using a Urologic Bugbee electrocautery, we de- epithelialized the tract. Next, Tisseel fibrin sealant was injected into the tract, closing it off. The bronchoscope was removed and the patient was admitted overnight for observation. She did well with no desaturations or complications and was discharged home on post op day #1. DOI: http://dx.doi.org/10.17797/nqf3kv0qyp

Injection Laryngoplasty for Type 1 Laryngeal Cleft

Schools: Children's Hospital of Pittsburgh Injection Laryngoplasty for type 1 laryngeal cleft is done with first identifying the deep cleft by palpation of the interarytenoid notch. Once a confirmation is made the larynx is suspended with a laryngoscope. Radiesse voice gel is then primed in a laryngeal needle and the needle is placed at the apex of the cleft. The needle is then pushed to palpate the cricoid cartilage with the bevel of the needle pointing towards the esophageal surface. The needle is then slightly retracted and about 0.2 ml of voice gel is injected. Care is taken not to make multiple punctures and the subglottisis watched so that the injection does not inadvertently go into subglottis. DOI: http://dx.doi.org/10.17797/g5r116zy3n

Robotic Assisted Type 1 Laryngeal Cleft Repair

Contributors: Umamaheshwar Duvvuri (University of Pittsburgh Medical Center) A DaVinci Robot is used to dock in with a 30 degree up telescope.The oral cavity is exposed using a FK retractor or a modified McIvor mouth gag( one with a flat blade). Robotic 5 mm Maryland forceps and 5 mm monopolar diathermy forceps is used. After getting a good exposure of the laryngeal cleft the diathermy at a setting of 4-5 watts is used to make the incision.and using the maryland forceps the laryngeal and esophageal flaps are created.A 5.0 PDS suture with a P2 tapered needle is used.The apex of the esophageal flap is first closed with suturing it.After this the apex of the laryngeal surface is closed.For a laryngeal cleft repair 2-4 sutures are required to obtain a closure. The sutures on the laryngeal surface are buried.The patient is kept intubated for a day or two to avoid excess movement of larynx. Pre and post operative treatment of reflux is important for healing. DOI: http://dx.doi.org/10.17797/z17zngnuwp

Pediatric Robotic Epiglottopexy

This is a patient with persistant laryngomalacia with stridor and Obstructive sleep apnea at 3 years of age. A flexible laryngoscopy showed prolapse of epiglottis into the airway. The patient had nasotracheal intubation and a suture was place through the anterior tongue to pull it forward while a modified McIvor mouth gag was placed with a short blade to expose the tongue base and epiglottis. The DaVinci robot is then docked with a 30 degree forward lens. A 5mm maryland forceps and a 5 mm bovie is used.The epithelium off the tongue base and the lingual surface of epiglottis is then denuded with a bovie at a setting of 10 after this is done the epiglottis is sutured to the tongue base with a 4.0 vicryl suture. A total of two or three sutures are placed with 3-4 knots on each suture. The patient is extubated and monitered overnight with 2-3 doses of Steroids. DOI: http://dx.doi.org/10.17797/z6vqam37jc

Endoscopic Balloon Dilation of Tracheal Stenosis

A 16 year old presented with stridor three after being intubated for a week following a head injury. Endoscopy revealed a long segment tracheal stenosis in a subacute phase. The airway was sized with a uncuffed 3.5 endotracheal tube with a leak at 20cm of water.This stenosis was Grade 3 Cotton-Myer classification. A 12 mm Vascular balloon (Boston Scientific-Blue Max) was placed in the in the airway with direct visualization and was dilated at 20 atmospheres for about a minute. The patient was under general anaesthesia but spontaneously breathing throughout the procedure. The patient was sized to a 6.5 endotracheal tube with a free leak after the dilation. DOI: http://dx.doi.org/10.17797/n35d0ug41t

ND:YAG Laser Therapy of Tongue Venous Malformation

This is a visual representation of the treatment of a venous malformation within the substance of the tongue. The laser directly treats the venous malformation via selective photothermolysis while preventing injury to the tongue itself. Venous malformations infiltrate normal tissue as a birthmark but continue to grow with time and show no evidence of regression. Instead of excising the venous malformation with some of the tongue itself this is a way of controlling the lesion. As seen, the ND:YAG laser set at 25 Watts and 1.0 sec duration is used to shrink the venous malformation. The laser is fired in a polkadot fashion in order to prevent mucosal sloughing. The surface is relatively protected as the laser selective penetrates the VM. DOI: http://dx.doi.org/10.17797/938qzyj3uh

Adenotonsillectomy: Basic Technique Using Electrocautery

Contributors: Deepak Mehta (Children's Hospital of Pittsburgh of UPMC) Purpose: Adenotonsillectomy is a procedure removing the tonsils and ablating the adenoids. Most commonly this is performed when the tonsils and adenoids have become obstructive, causing sleep disordered breathing or sleep apnea, or are recurrently or chronically infected. Key Instruments: McIvor mouth gag, Curved and Straight Allis clamps, Monopolar electrocautery with insulated blade set at 15W for removal, suction monopolar cautery set at 35 for adenoidectomy and 20 for cauterization of the tonsillar fossa. Anatomical Landmarks: Anterior and posterior pillars of the tonsil, vomer, torus tubarius of the Eustachian tube. Procedure: Tonsillectomy begins by placing the McIvor mouth gag into the oral cavity. The soft palate is palpated to assess for submucous cleft palate. One tonsil is grasped with the Allis clamp and retracted medially. This allows identification of the lateral extent of the tonsil. A mucosal incision is made at or slightly medial to the lateral extent and the fascial plane is entered between the tonsil and the pharyngeal musculature. Continuing in this plane throughout the dissection, the tonsil is effectively removed. The posterior pillar must be preserved. Hemostasis of the tonsillar fossa is achieved using the monopolar electrocautery. The contralateral tonsil is removed similarly. Monopolar adenoidectomy is performed using indirect mirror visualization of the adenoid tissue. Suction electrocautery is used to ablate the adenoid tissue up to the posterior choana and lateral to the torus tubarius. Conflict of Interest: None DOI: http://dx.doi.org/10.17797/xaqg93x7hy

Epiglottopexy for Severe Laryngomalacia with Epiglottic Prolapse

Contributors: Deepak Mehta (Children's Hospital of Pittsburgh of UPMC) Laryngomalacia is the most common cause of stridor in newborn infants. The majority of cases resolve spontaneously. Common surgical therapy consists of division of the aryepiglottic folds combined with trimming of the arytenoid mucosa and/or cuneiform cartilages. Less frequently, epiglottopexy is required. Initially, flexible laryngoscopy illustrated prolapse of the epiglottis into the laryngeal lumen causing severe obstruction. Microlaryngoscopy, bronchoscopy, and supraglottoplasty (division of the aryepiglottic folds only) were performed, however improvement did not occur due to persistent epiglottic prolapse. Transoral epiglottopexy was performed. A Lindholm laryngoscope was used for exposure. A needle point cautery was used to remove the mucosa of the lingual surface of the epiglottis and the base of tongue. Alternatively, a carbon dioxide laser could used. 5-0 polydioxanone suture on a P-2 needle was to suspend the epiglottis to the base of tongue using 3 sutures. Photographs of the suspension conclude the procedure. DOI: http://dx.doi.org/10.17797/locmhv8x9q

Hemangioma Excision

Infantile hemangiomas are vascular tumors composed of proliferating endothelial cells. They uniquely undergo rapid expansion from birth to 6-8 months of age and subsequent slow dissolution over several years thereafter. Some hemangiomas are at risk of causing functional problems during their growth phase as seen in this upper eyebrow lesion obstructing the visual axis. Laser, surgical and medical treatment options are available for problematic hemangiomas. This patient was elected to undergo excision to completely remove the lesion and forego a long course of medical therapy (propranolol). Because of the their vascular nature, excision of hemangiomas requires careful planning and hemostasis. The hemangioma is marked in elliptical fashion along natural aesthetic facial lines along the brow. The inferior mark in incised first. Careful subdermal dissection is critical to completely excise to the hemangioma near the surface and find the appropriate plane. Control of bleeding is maintained by monopolar and bipolar electrocautery as well as dissecting the lesion from one side and alternating to the other. The plane of deep dissection is rarely below the subcutaneous layer thus protecting important nerves and vessels. Complete removal is possible. Closure is performed with dissolvable monocryl or PDS suture with dermabond superficially. A plastic eyeshield (blue) is placed at the beginning of case to protect the patient's cornea during the procedure. DOI: http://dx.doi.org/10.17797/zlvhux8afu

Robotic Assisted Pediatric Lingual Tonsillectomy

The patient is nasotracheally intubated with a regular cuffed nasotracheal tube. Using a modified McIvor mouth gag, the oral cavity is exposed with the tip of the blade just shy of the posterior 1/3 of tongue so that the tongue base is clearly visualized. The DaVinci robot is set in and using a 5 mm forceps and a mono polar diathermy the incision is made in the midline and the lingual tonsil is dissected out as it is peeled off from the tongue base muscles which is very clearly visualized. The forceps is used to gently retract the tissue while the bovie at a setting of 15 is used to remove the lingual tonsils.. At the end the operative site is irrigated to check for any bleeders. FLOSEAL is also applied to help in hemostasis. DOI: http://dx.doi.org/10.17797/q82n9gkkvs

Airway Evaluation Prior to Closure of Tracheo-Cutaneous Fistula

The patient is a five year old, ex 23 week preemie whom was successfully decannulated with the tracheotomy removed in the ICU eleven months prior. The child did not have any airway reconstruction. As the techniques around decannulation as well as closure of trachea-cuteanous fistula are varied and at times controversial, it would be most excellent to see video sequences of the various ways to decannulate. The patient underwent a direct laryngoscopy and bronchoscopy and closure of the tracheo-cutaenous fistula. He is brought to the operating room for closure of a tracheo-cutaneous fistula. Prior to closure of the fistula, the patient had an airway evaluation to ensure that the airway was safe. Note the distal secretions and otherwise normal airway evaluation. The method for the airway evaluation in the setting of a trachea-cutaenous fistula is to first ensure the patient has adequate ventilation and oxygenation. If necessary and a very large fistula, the fistula may need to be covered with gauze or a finger to allow gas exchange. The airway evaluation then proceeds with a laryngoscope to expose the larynx and an endoscopic camera via a bronchoscope is passed through the vocal folds to evaluate the airway. This video demonstrates that there is no mucosal opening where the trachea-cutaneous fistula would be expected to be found. DOI: http://dx.doi.org/10.17797/k7e0zijclp

Coblation Adenoidectomy

Coblation (radiofrequency ablation) has become popular and the tool of choice for over half of Otolaryngologists. There has been legitimate concern about the ability to use the device for an adenoidectomy. This video shot using a mirror to examine the nasopharynx demonstrates the feasibility and ease of using the Coblation wand to perform an adenoidectomy. Note how easy the instrument can reach the posterior choanae and completely remove the adenoids safely. For the adenoidectomy, the surgeon can alternate between a setting of 9 ablate and 5 coagulation; both the ablation and coagulation modes are safe and beneficial when performing a coblation adenoidectomy. DOI: http://dx.doi.org/10.17797/otrlwb14g2

Endoscopic Drainage of a Severe Subperiosteal Abscess - Less is More

An adolescent male presented with a few day history of right eye swelling, erythema, and edema. The eye swelling was determined to be a result of subperiosteal abscess of the medial orbit, as seen on imaging. The vision was progressively getting worse and the decision was made to urgently take the patient to the operating room. The surgical indications are at times controversial but include decreased range of motion of the eye as well as loss of vision/color discrimination. This patient only had markedly decreased range of motion of the eye. The patient was taken to the operating room; afrin pledgets were placed and the middle turbinate was medialized. At this time the edema and swelling of the ethmoid sinuses was evident. The traditional teaching is to remove the ethmoid air cells and open up the lamina papyrecea. For the past several years, the author has adopted a less is more approach - where the author opens up the ethmoid sinuses and exposes the lamina to allow the pus a route of egress. This video clearly epitomizes the less is more approach. The ethmoid cells have been opened up and there is a large route of egress for the pus which is under pressure. The video demonstrates that upon palpation of the right eye (the Stankiewicz maneuver), there is a massive amount of pus that drains out. The child recovered expeditiously. Endoscopic sinus surgery is an area where is there significant potential for errors and complications - especially inadvertent injury to the eye and brain. As such, the author believes that in some cases, a less is more approach ultimately benefits the patient. DOI: http://dx.doi.org/10.17797/13t22bikb2

Orbital Fat Intentional Exposed Endoscopically

The mystery of orbital fat should not be so intimidating. The surgical mantra for chronic rhinosinusitis is to not expose orbital fat, however in specific instances it is imperative to take down the lamina papyracea to expose the orbital fat. Instances where this would be necessary would be for infections, tumors, orbital decompression as well as others. Specifically in this case, we surgically opened the maxillary antrum and took down the anterior ethmoid air cells. From here, we dissected laterally to the lamina papyracea and opened up the lamina where the orbital fat is exposed. This video shows that when you compress on the orbit the orbital fat moves and is displaced towards the path of least resistance in this case the opened up lamina and hence the fat moves towards the ethmoid air cells (ie medial). DOI: http://dx.doi.org/10.17797/wmjp1t36k5

Transoral Robotic Assisted Radical Tonsillectomy

Contributors: Jeffery Scott Magnuson (University of Central Florida) 1) Purpose: The patient had a history of biopsy proven squamous cell carcinoma of the right palatine tonsil and elected for surgical resection as a primary treatment. 2) Instruments: The DaVinci surgical robot was used with the Maryland dissector and a monopolar cautery on the arms. The FK retractor was used to suspend the patient and gain exposure. 3) Landmarks: The right palatine tonsil is resected along with a cuff of pharyngeal musculature. 4) Procedure: In sequence, the initial incision on the anterior tonsillar pillar, the exposure of the parapharyngeal space, the removal of the specimen, and the final defect are shown. 5) Conflicts of interest: for JSM: Intuitive Surgical: Instructor/Proctor, Honoraria; Lumenis: Consultant, Honoraria; Medrobotics: Member Strategic Advisory Panel, Honoraria. 6) References: Chung, T. K., Rosenthal, E. L., Magnuson, J. S. and Carroll, W. R. (2014), Transoral robotic surgery for oropharyngeal and tongue cancer in the United States. The Laryngoscope. http://dx.doi.org/10.1002/lary.24870 DOI: http://dx.doi.org/10.17797/kjwgjsgxwk

Supraglottoplasty for Laryngomalacia (Cold Steel)

1. Purpose of Surgery: To alleviate upper airway obstruction secondary to laryngomalacia after failed medical management (twice daily proton pump inhbitor, reflux precautions). Indications for surgery are the following: failure to thrive, dysphagia, aspiration, cyanosis, sleep apnea, pulmonary hypertension, core pulmonale, pectus excavatum. Approximately 10% of children with laryngomalacia will meet criteria for surgery. 2. Instruments: Parson's laryngoscope, Medtronic MicroFrance Bouchayer Laryngeal instruments (heart shaped forceps, fine cup forceps, Micro Scissors curved right &left, micro suction), oxymetazoline soaked pledgelet 3. Landmarks: vallecula, epiglottis, aryepiglottic fold, cuneiform cartilage, interarytenoid space 4. Procedure: a. Larynx sprayed with topical 2% lidocaine. and a direct laryngoscopy and bronchoscopy is performed to rule out a synchronous airway lesions. b. Parson's laryngoscope placed in the vallecula and in suspension with the patient spontaneously breathing. Inhalational anesthesia is given through sideport of laryngoscope. c. If the aryepiglottic fold is shortened then it is divided with a curved micro scissor at its attachment to the epiglottis. Division proceeds until the epiglottis is released and it springs anteriorly. (Special care should be taken to not divide the pharyngoepiglottic fold). d. If the cuneiforms cartilage is prolapsing into the airway then it is grasped with a small cup forcep or heart shaped forcep and removed with a curved scissor making sure not to remove mucosa/tissue in the interarytenoid region. e. Hemostasis is achieved with an oxymetazoline soaked pledge let. f. Steps c, d, and e are repeated on the contralateral side. g. Patient remains extubated and transferred to the intensive care unit. Decadron 0.5mg/kg every 8 hours for 24 hours. Twice daily proton pump inhibitor and reflux precautions for at least 30 days and then weaned off. h. Clinical swallow evaluation is performed 4 hours postoperatively and patient resumes age appropriate diet. i. Flexible fiberoptic laryngoscopy is performed one week postoperatively. 5. Conflict of interest: none 6. References: none DOI#: http://dx.doi.org/10.17797/cb0bwa6ggv

Endoscopic Repair of Type 1 Posterior Laryngeal Cleft

1. Purpose of the Procedure: To repair a type 1 posterior laryngeal cleft that is resulting in feeding difficulty and aspiration which fails medical management. 2. Instruments: Parsons Laryngoscope, Lindholm vocal fold spreader (Karl Storz 8654B), Double armed 5.0 Vicryl 45 cm dyed suture on a tapered needle, Omniguide carbon dioxide laser (5 watts, pulsed mode), Microlaryngoscopy right sided curved alligator, Knot pusher 3. Landmarks: The false vocal folds should be separated with a Lindholm vocal fold spreader allowing for good visualization of the interarytenoid region. 4. Procedure: a. Parson's laryngoscope placed in the vallecula and in suspension with spontaneous ventilation b. Lindholm vocal fold spreader inserted exposing the interarytenoid region. c. Interarytenoid region is demucosalized in a diamond shape with a carbon dioxide laser (5 watts, pulsed mode). The char is wiped clean with a pledglet. d. A double armed needle with a dyed 5.0 tapered Vicryl suture should be loaded on to a right sided microlaryngoscopic curved alligator in "fishhook" fashion. One arm is pushed through the right side and one arm is pushed through the left side of the corners of the demucosalized region. This will ensure that the knot sits posteriorly. (A dyed suture will also allow for easy visualization of the suture postoperatively in the office) e. Clinical swallow evaluation on postoperative day #1. Postoperative follow up and swallow study on Day #7. Additional follow up on postoperative day #30 5. Conflict of Interest: none 6. No references DOI: http://dx.doi.org/10.17797/f0jsgqdoup

Revision Supraglottoplasty

1. Purpose of Surgery: To alleviate upper airway obstruction secondary to recurrent laryngomalacia after failed initial supraglottoplasty. Reasons for failing initial surgery can be a conservative initial supraglottoplasty or severe reflux with failure to comply with postoperative reflux protocol. Preoperative consultation is obtained with a pediatric gastroentrologist to perform a full gastrointestinal evaluation. 2. Instruments: Parsons laryngoscope, Medtronic MicroFrance Bouchayer Laryngeal instruments (heart shaped forceps, fine cup forceps, Micro Scissors curved right & left, micro suction), oxymetazoline soaked pledget 3. Landmarks: vallecula, epiglottis, aryepiglottic fold, cuneiform cartilage, interarytenoid space 4. Procedure: a. Larynx sprayed with topical 2% lidocaine. b. Parsons laryngoscope placed in the vallecula and in suspension and patient is intubated. c. Aryepiglottic fold is redivided with a curved micro scissor at its attachment to the epiglottis. Division proceeds until the epiglottis is released and it springs anteriorly. (Special care should be taken to not divide the pharyngoepiglottic fold). d. One side of the curved epiglottis is grasped with a small cup forcep or heart shaped forcep. The epiglottis is then trimmed with a curved scissor (mucosa and cartilage). e. Hemostasis is achieved with an oxymetazoline soaked pledget. f. The patient remains extubated and is transferred to the intensive care unit. The patient is given Decadron at a dosage of 0.5mg/kg every 8 hours for 24 hours following the procedure and twice daily proton pump inhibitor and reflux precautions for at least 30 days and then weaned off. g. Clinical swallow evaluation is performed 4 hours postoperatively and patient resumes age appropriate diet. h. Flexible fiberoptic laryngoscopy is performed one week postoperatively. 5. Conflict of interest: none. 6. References: none DOI: http://dx.doi.org/10.17797/ag049330ri

Ear Tube Removal and T-tube Replacement

Contributors: Gresham T. Richter (University of Arkansas for the Medical Scienc) 1) Purpose: Untreated Eustachian Tube dysfunction can lead to retraction of the tympanic membrane (TM) and, eventually, an atelectatic middle ear. The insertion of a tympanostomy tube attempts to equalize the air pressure of the middle ear with the environment, allowing for the stabilization of the TM. Bobbin style tubes have an average extrusion time of less than a year while T-tubes remain in place longer but risk residual perforation. (1) 2)Instruments: Rigid endoscopes were used to direct and record the procedure with standard video monitoring. Straight cupped forceps were used to debride the external auditory canal. A myringotomy knife was used to make the myringotomy. 3) Landmarks: After debridement of cerumen, the handle of the malleus and the incudostapedial joint are clearly visualized as indicated with titles in the video. Note that the patient's tympanic membrane shows an incudostapediopexy and deep retraction which is not the typical tympanic membrane position. 4) Procedure: Cerumen is debrided from the EAC. A myringotomy knife is used to enter the middle ear space which is suctioned. A t-tube is placed, and the position is confirmed. 5) Conflict of Interest and Source of Funding The authors have no financial disclosures. 6) References 1. Weigel MT, Parker MY, Goldsmith MM, Postma DS, Pillsbury HC. "A prospective randomized study of four commonly used tympanostomy tubes." The Laryngoscope. 1989 Mar;99(3):252-6. http://dx.doi.org/10.1288/00005537-198903000-00003 DOI: http://dx.doi.org/10.17797/7zpuk5q5r6

Multinodular Thyroid Gland with Cervical Lymphadenopathy Followed by Total Thyroidectomy

Purpose of procedure: To remove enlarged multinodular thyroid gland which was causing airway obstruction along with feeding difficulties. Landmarks: Two horizontal collar incision with skin crease above 2 finger breadths above the sternal notch. Procedure: 1. A horizontal incision of 2 finger breadth was made above the sternal notch and silk sutures were used for retraction of skin flaps. Subcutaneous flaps and platysma were divided and subplatysmal dissection was made above the incision up to the level of thyroid cartilage above and the sternal notch. 2. Strap muscles were separated with the help of retractor, exposing anterior surface of thyroid. 3. Thyroid gland was rotated medially to and middle thyroid vein was ligated. 4. Superior laryngeal artery was also ligated and external laryngeal nerve was spared during procedure. 5. Superior parathyroid was spared and identified at upper two third of thyroid at 1cm above crossing point of recurrent laryngeal nerve and inferior thyroid artery. 6. Similarly, inferior parathyroid was identified and spared which was located on the posterolateral surface of the lower pole of the thyroid. 7. Recurrent laryngeal nerve was preserved which was located between the common carotid artery laterally, the oesophagus medially, and the inferior thyroid artery superiorly. 8. Sternocleidomastoid was resected to explore the area adjacent to the lymph nodes involved. 9. Cervical lymph node involved was also removed, whereas the carotid artery, jugular vein, phrenic nerve, sympathetic ganglia, brachial plexus, were spared. 10. Eventually, thyroid gland was dissected and neck was sutured. Conflict of Interest and Source of Funding: none Acknowledgments: Author thanked the patient and surgeons later. DOI: http://dx.doi.org/10.17797/74w05qqfns

Hemiglossectomy with Tracheostomy

Contributors: Eswat Ahmad (Army Medical College, Rawalpindi, Pakistan) Purpose of procedure: This surgery includes removal of part of the tongue and adjacent tissues to treat carcinoma of tongue when other treatments have not been successful. Landmarks: Incision on the dorsum side extends from lateral side of the tip till foramen cecum while incision in the floor of the mouth extends up to anterior pillar of tonsil. Procedure: 1. Tracheostomy is done and then general anesthesia is administered. 2. Mouth is opened and mouth gag is inserted. Packing is placed in the oropharynx to prevent blood aspiration. 3. Two incisions are made as described. 4. Two halves of the tongue are then separated, genioglossus muscle is visible. Hypoglossal nerve and lingual artery are divided and clamped. 5. Posterior transverse incision is made and the remaining muscle fibers to the base of the tongue are divided. 6. Residual tongue is examined for any bleeding points. Conflict of Interest and Source of Funding: none DOI: http://dx.doi.org/10.17797/765bg9o8ie

Pressure Equalization Tube Placement

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

Costochondral Graft Harvest for Laryngoplasty

Rib cartilage is the workhorse autogenic material for laryngeal airway expansion surgery.  Most usually one will use the right-sided 5th or 6th rib as the donor site.  A 2.5 cm incision is made directly over the rib, in the inframammary crease from the lateral aspect of the nipple to the sternal xyphoid process.  Subcutaneous fat is removed.  The overlying intercostal muscles are dissected up away from the rib, divided, and retracted-- effectively exposing the rib.  Perichondrium is sharply incised on the superior and inferior borders of the rib.  A posterior tunnel is elevated in asub-perichondrial plane using blunt instruments, just medial to the osseocartilagenous (OC) junction.  A Doyen elevator is inserted into the tunnel and the rib is transected right at the OC junction.  The rib is then elevated from lateral to medial in the subperichondrial plane. Such a manuever ensures that the plueral space will not be entered, protecting the pleural membrane from injury. Once the rib has been elevated to the sternal attachment, it is completely released.  The pleura is inspected directly to confirm it has not been injured.  The wound is filled with normal saline and 30 cm of water pressure valsalva is applied by the anesthesiologist for 30 seconds, to ensure no air is escaping the lung.  The wound is closed in layers over a rubber band drain placed in a dependent position. One should be able to harvest 2.5-3 cm of cartilage. Post-operatively a chest radiograph is obtained to rule out pneumothorax DOI: http://dx.doi.org/10.17797/2jra6vjlud

Tonsillectomy Using Electrocautery

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

Cholesterol Granuloma Petrous Apex Revision

Contributors: Ravi N. Samy, M.D., F.A.C.S (University of Cincinnati / CCHMC) and  Shawn Stevens, M.D. Cholesterol granuloma recurrence at the petrous apex.   The patient had a prior surgery performed without stenting. Revision surgery at UC performed with double-barrel stent placement. External Related Links: www.cisurgeon.org    www.youtube.com/user/cisurgeon DOI: http://dx.doi.org/10.17797/vvmrb6t77g Editor Recruited By: Ravi N. Samy, MD, FACS

Awake Steroid Injection for Idiopathic Subglottic Stenosis

Contributor: Michael Johns III, MD This video demonstrates a steroid injection in an awake patient for the treatment of idiopathic subglottic stenosis. The patient is first anesthetized with topical 2% lidocaine over the larynx and 1% lidocaine with epinephrine percutaneously over the cricoid cartilage. An endoscope is passed transnasally and positioned just below the vocal folds. A 23 gauge needle is then passed through the cricothyroid membrane, and Kenalog is circumferentially injected submucosally taking care not to reduce the caliber size of the airway. DOI: http://dx.doi.org/10.17797/htvmbepobg

Stentless Choanal Atresia Repair

Choanal atresia (CA) occurs in roughly 1:5000-7000 live births. It affects females twice as often as males, and occurs bilaterally in roughly 50% of cases. Bilateral choanal atresia (BCA) is typically repaired in the newborn period as soon as the child is medically stable; tracheostomy for BCA alone has been widely abandoned. Unilateral CA repair is often deferred until age 2-3 years. Traditional techniques of endoscopic repair involved placing stents in the nasopharynx traditionally made of cut and shaped endotracheal tubes or silicon tubing stents. Stentless repair offers the advantage of decreased foreign body reaction in the nasopharynx causing granulation and scarring, and involves much less maintenance for families after discharge. In this technique, the procedure is performed endoscopically 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 to prevent scarring and restenosis. Postoperatively, babies are empirically treated with reflux medications and a short course of antibiotic and steroid drops in the nose; a second look procedure is recommended 4-6 weeks postop to ensure healing and confirm patency. Editor Recruited By: Sanjay Parikh, MD, FACS DOI: http://dx.doi.org/10.17797/6w5u6drd5e

In-Office Awake Vocal Fold Steroid Injection

Contributors: Clark A. Rosen Superficial injection of steroids into the true vocal folds can be performed to reduce or prevent vocal fold scar formation as well as for treatments of benign vocal fold lesions. DOI: http://dx.doi.org/10.17797/zle2prpaif Editor Recruited By: Michael M. Johns, III, MD

Awake Trancervical Injection Laryngoplasty - Thyrohyoid Membrane Approach

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

Pediatric Ansa to Recurrent Laryngeal Nerve Reinnervation

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

Choanal Atresia Repair

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

Bilateral Dacryocystoceles Resection

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

Vocal Fold Lipoinjection

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

Open Posterior Graft Laryngoplasty

This video highlights the key points of successful open posterior costochondral laryngoplasty. DOI: http://dx.doi.org/10.17797/i6v1c8ghhg

Laser Assisted Endoscopic Removal of Lower Tracheal Tumour

This video shows a KTP laser assisted endoscopic excision of a myofibroblastic lower tracheal tumour. Editor Recruited By: Sanjay Parikh, MD, FACS DOI: http://dx.doi.org/10.17797/jt8idqw53j

Treatment of Adult Idiopathic Subglottic Stenosis with CO2 Laser and Balloon Dilation

Contributors: Michael M. Johns III and Benjamin Anthony The patient is a 53 year-old female with history of idiopathic subglottic stenosis and long-standing right vocal fold scarring who had previously been treated endoscopically in the operating room and in the office with steroid injections. She returns to the operating room for scheduled endoscopic CO2 laser treatment, Depo-Medrol injection (not shown), balloon dilation, and Mitomycin C application (not shown). DOI: http://dx.doi.org/10.17797/p7s4gn9n20 Editor Recruited By: Michael M. Johns, III, MD

Endoscopic Tracheoesophageal Fistula Repair

Contributors: Noemie Rouillard-Bazinet, MD and Deepak Mehta, MD Endoscopic repair of tracheoesophageal fistula using electrocautery and fibrin glue. DOI: http://dx.doi.org/10.17797/uq9ifhudgd Editor Recruited By: Sanjay Parikh, MD, FACS

In-Office KTP Treatment of Recurrent Respiratory Papillomatosis

Contributors: Clark A. Rosen Laryngeal recurrent respiratory papillomatosis can be treated in the office using a 532-nm pulsed KTP laser under local anesthesia while the patient is awake without sedation. DOI: http://dx.doi.org/10.17797/5ar3jihu3g Editor Recruited By: Michael Johns III, MD

Endoscopic Removal of Suprastomal Granuloma Using a Flexible KTP laser

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

Endoscopic Ear Surgery - Incus Interposition for Traumatic Ossicular Discontinuity

A five year old with conductive hearing loss due to traumatic ossicular discontinuity presents for surgical management. Ossicular discontinuity with a fibrous union of the incudostapedial joint is identified. Transcanal Endoscopic middle ear exploration with incus interposition is performed. DOI: http://dx.doi.org/10.17797/t0il7famg9 Editor Recruited By: Sanjay Parikh, MD, FACS

Posterior Cricoid Split and Costal Cartilage Grafting for Bilateral Vocal Fold Paralysis

Contributors: Noemie Rouillard-Bazinet and Julina Ongkasuwan Bilateral vocal fold paralysis causes airway obstruction and, in some patients, tracheostomy dependence. Posterior cricoid split with costal cartilage grafting can open the posterior glottis and improving the airway. DOI: http://dx.doi.org/10.17797/hyp0b3mzd5 Editor Recruited By: Michael M. Johns III, MD

Middle Fossa Transventricular and Subtemporal Approach for Meningioma Resection

Contributors: Micheala Lee This is a demonstration of using the transventricular and subtemporal corridors for resecting a large middle fossa, tentorial meningioma. The video details the microsurgical technique for detaching the tumor from the tentorial incisura, working near critical structures such as the oculomotor nerve, trochlear nerve, and posterior communiating artery. It also includes precise demonstration of how to separate the massive tumor from the feeding arterial supply stemming from the posterior cerebral artery. DOI: https://doi.org/10.17797/nbtj2jdx6l

Transoral drainage of a Retropharyngeal Abscess

Retropharyngeal and parapharyngeal abscess are common in the pediatric population. When medial to the great vessels, a transoral approach to incision and drainage avoids the potential morbidity of external incisions and dissection through the parapharyngeal space. DOI: http://dx.doi.org/10.17797/cbobe92kzw

Endoscopic Excision of Concha Bullosa

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

Transcanal Endoscopic Infracochlear Approach for a Petrous Apex Cholesterol Granuloma

This video demonstrates a transcanal endoscopic infracochlear approach to the petrous apex in a patient with a large cholesterol granuloma. The patient presented with a history of profound left sensorineural hearing loss, hemifacial spasm, and House Brackmann Grade 2 facial function. Preoperative imaging demonstrated a T1 and T2 hyperintense heterogenous lesion in both petrous apices with the left being larger than the right on magentic resonance imaging. A computed tomography scan (CT) of the temporal bones demonstrates extension of the left petrous apex lesion into the internal auditory canal and cochlea. Dr. Isaacson has had 2 patients who have had significant recovery of their bone line after using an infracochlear approach. In the unlikely event that the patient experiences hearing loss in the other ear, their cochlea is preserved for a possible CI. However, the patients hearing loss is likely secondary to the 8th nerve involvement of cholesterol granuloma erosion into IAC. The patient in this surgical video has been monitored for a year. One year postop CT shows aeration of the apex. This patient's facial spasm has resolved. Dr. Isaacson has used stents in the past, but in this case felt the opening was large enough that he could forego it. Patient did not recover their hearing. DOI: http://dx.doi.org/10.17797/1wq11j68wa

Right Stapedotomy

Otosclerosis causes conductive hearing loss with absent acoustic reflexes. Stapedotomy is a successful surgery that is demonstrated in this video. Editor Recruited By: Ravi Samy, MD, FACS DOI: http://dx.doi.org/10.17797/6c3g45u2tw

Fascia with Bone Pate Resurfacing Technique for Repair of Superior Semicircular Canal Dehiscence

Contributors: Jacob B. Hunter, Reid C. Thompson and David S. Haynes Superior semicircular canal dehiscence (SCD) is a condition in which the bone overlying the superior semicircular canal is absent. The clinical presentation of SCD is highly variable and may include both auditory and vestibular manifestations. The more common symptoms include autophony, sound or pressure induced vertigo, hypersensitivity to sound, and low frequency conductive hearing loss. Repair can be accomplished via either transmastoid or middle fossa approaches, with numerous materials used to either plug or resurface the canal. Herein, we describe our resurfacing technique using a loose areolar tissue-bone pâté-loose areolar tissue sandwich through a middle fossa approach. DOI#: http://dx.doi.org/10.17797/kcwvab3b7r

Rib Cartilage Harvest for Laryngotracheal Reconstruction

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

Transoral Resection of Stylohyoid Ligament

Contributors: Raj Dedhia, M.D Eagle’s Syndrome, also known as Styloid Syndrome, is defined by the presence of an elongated, misshapen, or calcified stylohyoid ligament. It is characterized by pain localized to either side of the throat, odynophagia, and referred otalgia. Transoral removal of the stylohyoid ligament consists of transecting the stylohyoid ligament to release tension and result in improvement of pain. DOI #: https://doi.org/10.17797/o3iz10qacz

Microvascular Decompression for Trigeminal Neuralgia (combined venous & arterial)

Contributors: Fadi Sweiss Microvascular decompression is the most effective surgical procedure for treating trigeminal neuralgia in patients with classic symptoms. Here we present a patient who had a "duo crush" from both a vein, as well as a loop of the superior cerebellar artery. The key maneuvers to create space between the compressive element and the nerve, in order to secure the teflon "cushion," are highlighted. DOI: https://doi.org/10.17797/qgthi9k07c

Excision of Thyroglossal Duct Cyst

Contributors: Juliana Bonilla-Velez and Gresham Richter This patient presented with an anterior neck mass that was mobile with tongue movement. This is consistent with a thyroglossal duct cyst.  The following video demonstrates the excision of a thyroglossal duct cyst using the Sistrunk procedure. DOI#: http://dx.doi.org/10.17797/oelc9n6wlc

Microsurgical resection of an acoustic neuroma via the translabyrinthine approach

Contributors: H. Jeffrey Kim The translabyrinthine approach has often been reserved for large acoustic neuromas because it requires less retraction on the cerebellum when compared to the retrosigmoid approach for a similar tumor. However, the translabyrinthine approach is equally useful for smaller tumors, when the patients has no residual ipsilateral hearing. It allows for early visualization of the facial nerve, and thus better protection of this crucial nerve. DOI #: http://dx.doi.org/10.17797/168b12z8m4

Endoscopic Posterior Cricoid Split with Rib Grafting for Posterior Glottic Stenosis

Endoscopic posterior cricoid split with rib grafting can be used in children with Bilateral Vocal Fold Immobility due to bilateral vocal fold paralysis or cricoarytenoid joint fixation with posterior glottic stenosis. It is preferred to open laryngotracheal reconstruction because it does not disrupt the anteior cricoid ring therby preserving the "spring" of the cricoid. DOI#: http://dx.doi.org/10.17797/5w4hsqmgnq

Endoscopic DCR and Dacryolith Removal

Contributors: Nicolas Biro This video displays a left sided Endoscopic DCR with lit pipette assistance for a 25 year old patient with severe epiphora and pain from chronic dacrocystitis and dacryolith. DOI: http://dx.doi.org/10.17797/r6p89jf9in

Transoral Laser Excision of a Lingual Thyroglossal Duct Cyst

Contributors: Blaine D. Smith and Jaecel Shah The lingual thyroglossal duct cyst (LTGDC) is a rare variant of the most common congenital neck mass, the thyroglossal duct cyst. The presentation of this atypical cyst is often due to symptoms of upper airway obstruction, and can lead to infant death if left untreated.

Translabyrinthine Approach for Vestibular Schwannoma (Acoustic Neuroma) Resection

Contributors: Bruce E. Mickey and J. Walter Kutz This video highlights key steps to the translabyrinthine approach for vestibular schwannoma resection. It emphases identification of the facial nerve and the benefit of facial nerve monitoring in lateral skull base surgery. DOI#: https://doi.org/10.17797/4w83z6uxam

Microtia Reconstruction: Stage 1

Stage 1 Microtia Repair using rib cartilage and modifications to the Nagata method of auricular formation. DOI#: http://dx.doi.org/10.17797/cquv22l7p3

Endoscopic Posterior Cricoid Split with Rib Grafting for Bilateral Vocal Fold Paralysis

Endoscopic posterior cricoid split with rib grafting can be used in children with bilateral vocal fold immobility due to bilateral vocal fold paralysis or cricoarytenoid joint fixation with posterior glottic stenosis. It is preferred to vocal cordotomy/arytenoidectomy because it is a non-destructive procedure with no impact on voice and swallowing.  It is also preferred to open laryngotracheal reconstruction because it does not disrupt the anterior cricoid ring thereby preserving the "spring" of the cricoid. DOI: http://dx.doi.org/10.17797/gcnyoduseo

Endoscopic Endonasal Approach for Pituitary Tumor Resection

Contributors: Timothy R. DeKlotz With the widespread use of the endoscope in pituitary surgery, many technical nuances have emerged. Some surgeons still use a sublabial incision and a speculum, despite using the endoscope for visualization, while others favor approaches that are purely endonasal. Some surgical teams, using an endoscope-holder, work sequentially and individually, while others prefers two surgeons working together simultaneously. In this video, we demonstrate an endoscopic endonasal approach, in which the tumor resection is performed with a 4-hand technique with both surgeons working simultaneously. DOI#: http://dx.doi.org/10.17797//bdxmmtst16

Bilateral Cryptotia Repair

Contributors: Shira Koss 6 year old boy suffering from bullying at school as a result of bilateral cryptotia, a very unusual congenital ear anomaly in which the superior helix is buried under temporal skin. DOI#: http://dx.doi.org/10.17797/le4g6c5rk5

Cervical Esophageal Foreign Body Removal

Contributors: Christopher G Tang Rigid cervical esophagoscopy is an excellent procedure for removing cervical esophageal foreign bodies. In this video, it was used to removal an unknown foreign body. DOI: http://dx.doi.org/10.17797/kzn2ovjuve

Bilateral Sagittal Spilt Osteotomy and Genioplasty in Patient with Lymphatic Malformation

Contributors: Michael Golinko, MD,  John Jones, MD, DMD,  Kumar Patel, PA Bilateral sagittal split osteotomy and genioplasty in 5y/o girl with lymphatic malformation. DOI#: https://doi.org/10.17797/hlo056ep2r

LeFort I Osteotomy and Advancement in Patient with Maxillary Hypoplasia

Contributors: Michael Golinko, Kumar Patel and Bridget O'Leary LeFort I osteotomy and advancement in 18y/o female patient with maxillary hypoplasia DOI: https://doi.org/10.17797/1cu3tz50yf

Expansion Sphincter Pharyngoplasty

Contributors: Raj Dedhia, M.D Obstructive sleep apnea is a common disorder with many possible etiologies. Surgical therapy is aimed at reducing or eliminating an area of airway stenosis that predisposes patients to obstructive sleep apnea. Expansion sphincter pharyngoplasty consists of transecting the palatopharyngeus and reinserting it into the lateral soft palate and periosteum of the pterygoid hamulus to widen the pharyngeal airway. DOI #: https://doi.org/10.17797/i9jgkva8m4

Bilateral Cleft Lip Repair

Contributors: Larry Hartzell Repair of the bilateral cleft lip deformity can be challenging to the cleft and craniofacial surgeon.  The goals of an acceptable repair must include precise continuity of the cupid's bow, maximizing philtral length, and establishing a mucosa lined sulcus.  We present an example of a repair of the bilateral incomplete lip as described by Millard. DOI: http://dx.doi.org/10.17797/qefi9lqbam

Gray Minithyrotomy

Contributors: Michael Lerner and Lucian Sulica Gray Minithyrotomy with fat implantation DOI: https://doi.org/10.17797/5p22fy2gkx

Awake per-oral vocal fold injection with Calcium Hydroxyapatite

Contributors: Clark A. Rosen Peroral vocal fold augmentation provides the patient an opportunity for permanent or temporary vocal fold augmentation under local anesthesia, obviating a trip to the operating room and general anesthesia. DOI: https://doi.org/10.17797/q995b29rk7

Endoscopic Excision of Nasolacrimal Duct Cyst

The patient is a 4 week old female infant with right sided epiphora and complete right sided nasal obstruction resulting in respiratory and feeding difficulty.  Physical exam demonstrated a right medial canthal mass consistent with a dacrocystocele. Flexible fiberoptic nasal endoscopy demonstrated an anterior nasal mass below the inferior turbinate occluding the entire right nasal cavity consistent with a nasolacrimal cyst. The etiology is obstruction at the level of Hassner's valve.

EMG Guided Botulinum Toxin Injection for Adductor Spasmodic Dysphonia

Contributors: Christian Lava, Hagit Shoffel-havakuk, and Michael M Johns Iii Adductor spasmodic dysphonia is the most common form of laryngeal dystonia, causing inappropriate glottic closure and strangled choppy voice. This video demonstrates step by step, the standard treatment for adductor spasmodic dysphonia: bilateral, EMG-guided, percutaneous botulinum toxin injections to the TA-LCA (thyroarytenoid and lateral cricoarytenoid) muscles.

Adenoidectomy with Radiofrequency Ablation (Coblator) Technique

Contributors: Soham Roy and Steven Curry Adenoidectomy is among the most common surgical procedures performed in children.  The two major indications are nasopharyngeal airway obstruction and recurrent or chronic infections of the nasopharynx.  This surgery is often carried out with a combined tonsillectomy which is performed for similar indications and depicted here.

Modified Rambo Transcanal Approach for Cochlear Implantation in CHARGE Syndrome

Contributors: Amy M. Moore, and Brandon Isaacson CHARGE syndrome is associated with a variety of temporal bone anomalies and deafness. The lack of surgical landmarks and facial nerve irregularities make cochlear implantation in this population a challenging endeavor. This video describes a safe and efficacious transcanal approach for cochlear implantation that obviates the need to perform a mastoidectomy and facial recess.

CO2 laser wedge excision and steroid injection for Subglottic Stenosis

Contributors: Jan Kasperbauer Subglottic stenosis can occur from a variety of causes and is often treated with balloon dilation +/- CO2 laser radial incisions. This video shows an approach used for many years at our institution (wedge excisions without dilation) with good success.

Myringotomy with Tympanostomy Tube Insertion

Myringotomy with tympanostomy tube insertion is among the most common pediatric operative procedures and is indicated to provide ventilation of the middle ear. Surgical incision in the tympanic membrane (myringotomy) is followed by tympanostomy tube insertion to prevent premature closure of the incision site. The goal of the procedure is to reduce the frequency, duration, and severity of subsequent otitis media episodes and to prevent recurrence of middle ear effusions. Soham Roy (University of Texas at Houston Medical School) Thomas Mitchell (University of Texas at Houston Medical School)

Lingual Tonsillectomy with Epiglottopexy

Posterior displacement of the epiglottis secondary to lingual tonsil hypertrophy is a common cause for persistent obstructive obstructive sleep apnea after adenotonsillectomy in the pediatric population. By use of an operating micorscope an endoscpoic technique for lingual tonsillectomy and a epiglottopexy is described.

Microtia Reconstruction Stage 2

This is the second stage of Microtia Reconstruction, the first stage was depicted in a prior video. The ear is elevated and lateralized to take its 3-dimensional form, and this is accomplished with use of an anteriorly based mastoid fascial flap as well as costal cartilage graft and full thickness skin graft. Editor Recruited By: Michael Golinko, MD

Rhomboid Flap Reconstruction of Necrotic Cheek Lesion

The patient had an unidentified dermal filler placed outside of the United States over a decade ago. She developed a subsequent severe reaction which left her with extensive subdermal fibrosis and epidermal necrosis. Pathologic analysis revealed almost entire replacement of the dermal-epidermal layer with a foreign body and granulomatous reaction. The location at the cheek lower lid junction and the available lateral skin laxity deemed the rhomboid flap as the best option for reconstruction. Editor Recruited By: Michael Golinko, MD

Endolymphatic sac decompression

Contributors: Amelia Cussans and Mr Shreeshyla Basavaraj Music: Fifth Avenue Stroll Ménière's disease is an inner ear disorder, characterised by intermittent attacks of vertigo, fluctuating hearing loss, tinnitus and sense of pressure in the ear. The pathophysiology is not fully understood; however, it is believed to be associated with abnormal fluid regulation of the endolymph. Whilst medical therapy is sufficient in most cases, some patients require surgical intervention. Endolymphatic sac decompression is one of the surgical methods that can be employed in the treatment of patients with medically intractable Ménière's disease. It aims to reduce vertigo by relieving endolymphatic pressure in the cochlea and vestibular system. This video demonstrates Mr Sreeshyla Basavaraj’s surgical technique.

Microlaryngoscopy in a Child with Normal Anatomy

Contributor: Thomas Mitchell A laryngoscope is used to allow magnified visualization of the anatomy of the larynx in a pediatric patient. Labelled stills are used to demonstrate specific anatomy and landmarks. This procedure is indicated to diagnose and/or treat pathology of the airway and vocal cords. However, no pathology is seen in this patient.

Intracapsular tonsillectomy

Contributors: Dr. James Hamilton Intracapsular tonsillectomy using the microdebrider is demonstrated here in a child with obstructive sleep apnea.

Adenoidectomy with Suction Electrocautery Technique

Adenoidectomy is among the most common surgical procedures performed in children. The two major indications are nasopharyngeal airway obstruction and recurrent or chronic infections of the nasopharynx. This surgery is often carried out with a combined tonsillectomy which is performed for similar indications. The technique used in this video is suction electrocautery, a recently developed technique that allows for more precision and minimal blood loss compared with more traditional techniques. Soham Roy (University of Texas Medical School at Houston) Thomas Mitchell (University of Texas Medical School at Houston)

Tonsillectomy with Radiofrequency Ablation (Coblator) Technique

Tonsillectomy is among the most common surgical procedures performed in children. The two major indications are oropharyngeal airway obstruction and recurrent or chronic infections of the oropharynx. In this video, radiofrequency ablation, or Coblation (controlled ablation), is the technique used to ablate the tonsils. This technique uses low-temperature radiofrequency and saline to create a plasma field that dissolves tissue. It is generally safer that high-temperature electrocautery and allows for precise removal of tissue without burning nearby structures. Contributors: Soham Roy (University of Texas at Houston Medical School) Thomas Mitchell (University of Texas at Houston Medical School) Steven Curry (University of Texas at Houston Medical School)

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

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

Endoscopic Management of a Type IV Branchial Cleft Anomaly

Trans-oral endoscopic approach to exposure of a type IV branchial cleft anomaly sinus tract in the left piriform recess and closure using cauterization and tisseel application. Co-author: Yi-Chun Carol Liu

Mandibular Distraction for Micrognathia in a Neonate

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

Excision of Macrocystic Lymphatic Malformation

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

Endoscopic Resection of Concha Bullosa

Concha bullosa represents a benign entity that can present problems for the endoscopic sinus surgeon by limiting access and visualization to the middle meatus. Additionally, this may be a significant contributor to a patient's nasal obstruction, or the leading factor for osteomeatal complex obstruction. Endoscopic removal provides a quick, safe, and reliable means to deal with this issue and provide the appropriate surgery for the patient.

Tympanoplasty with tragal cartilage graft, postauricular approach

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

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.

Total Tonsillectomy

Total Tonsillectomy Sarah Maurrasse MD, Vikash Modi MD Weill Cornell Medicine, Department of Otolaryngology Tonsillectomy is one of the most common surgical procedures performed in children. The two main indications for tonsillectomy are sleep disordered breathing and recurrent infections, both of which are common in the pediatric population. This video includes 1) a detailed introduction including relevant anatomy 2) a discussion of the indications for total tonsillectomy 3) surgical videos and diagrams to explain the steps of the surgical procedure and 4) an explanation of possible post-operative complications.

Partial Tonsillectomy

Partial Tonsillectomy Sarah Maurrasse MD, Vikash Modi MD Weill Cornell Medicine, Department of Otolaryngology Tonsillectomy is one of the most common surgical procedures performed in children. The main indication for partial tonsillectomy is sleep disordered breathing, which includes a spectrum of disorders from primary snoring to obstructive sleep apnea (OSA). This video includes 1) figures of the anatomy relevant to partial tonsillectomy 2) a discussion of the indications for partial tonsillectomy and 3) surgical videos and diagrams that explain the steps of the surgical procedure.

Snare Tonsillectomy

Tonsillectomy is one of the most common surgeries performed today, yet debate continues regarding the best technique to avoid complications. We’ll review one method in this video, snare tonsillectomy, which is a "cold" technique. We'll discuss it's advantages over other methods, and a step-by-step instructional video.

Intraoperative Injection of Methylene Blue Dyed Fibrin Glue For 2nd Branchial Cleft Fistula Excision

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.

Combined drainage of subperiosteal orbital abscess complicating ethmoiditis

A 4 year-old boy presented to our tertiary center with acute left ethmoiditis and a subperiosteal orbital abscess. He presented with exophtalmia but had no visual impairment or limitation of ocular mobility. CT-scan found a 8 mm large subperiosteal orbital abscess with no further complications. Surgery was decided using a combined approach to drain the abscess and to obtain a bacterial sample: first external (incision in the inner canthus area) and then endonasal (functional endoscopic sinus surgery - FESS) to open the middle meatus and ethmoid. External approach: 10 mm incision in the inner canthus region, elevation of the lamina papyracea periosteum until the abscess was reached. Rubber drain was put in place for irrigation. Endonasal approach: after careful CT-scan examination, endonasal surgery was performed with a 30° rigid endoscope. The middle turbinate was medialised to expose the middle meatus, uncinectomy and antrostomy followed by anterior and posterior ethmoidectomy was performed. Antibiotics were given intravenously for 5 days and saline irrigation on the drain was performed during 2 days. Patient was discharged after 5 days.

Draping Technique for Major Ear Surgery during Pandemic!!!

Covid -19 Pandemic has changed the way we provide our healthcare services to our patients. ENT / Otolaryngology is one of the high risk speciality for contracting Covid infection. We as professionals has to take maximum precautions not only to protect our patients but also all our healthcare staff working with us in to minimise the risk of contracting the virus ((Krajewska). Unfortunately our patients do need appropriate necessary treatment for their otological problems during this pandemic. Drilling mastoid bone will generate significant aerosol during the procedure, putting everyone in the operating theatre at risk (Prof P Rae). Though every patient who undergoes any surgical procedure should have Covid test, self isolate and free from Covid symptoms. There is risk of contracting Covid infection from asymptomatic patient or staff. We should try and take every step to minimise the risk of contracting Covid infection either from Covid positive / negative Or symptomatic / asymptomatic patient or staff. There are few techniques been tried by our colleagues around the world to minimise aerosol during major ear surgery. We tried to use of the technique proposed by our colleagues in UK ( W. Hellier), as it was too cumbersome during the procedure, we propose the modified technique to drape the surgical site during major ear surgery to reduce the aerosol.

Total Facial Nerve Decompression via Combined Middle Fossa-Transmastoid Approach

This video demonstrates total facial nerve decompression via combined Middle Fossa-Transmastoid approach. Gavriel D. Kohlberg, MD,1 Noga Lipschitz, MD,1 Charles B. Poff, BS,2 MD, Ravi N. Samy, MD, FACS1,3 1 Department of Otolaryngology – Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA 2 College of Medicine, Medical University of South Carolina, Charleston, SC, USA 3 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA

Lateral Graft Tympanoplasty

Title: Lateral Graft Tympanoplasty Description: A lateral graft tympanoplasty is performed to demonstrate the utility of this technically challenging approach. The technical pearls that contribute to the high success rate of this graft are highlighted. Learning Points: The lateral graft tympanoplasty was popularized by Sheehy in the 1960s. Although technically more demanding than underlay graft techniques, the lateral graft is an essential method for Otologists to have in their armamentarium. The lateral graft is especially useful in cases of total perforation or anterior marginal perforation as well as revision tympanoplasty. Potential disadvantages of this technique include graft lateralization and anterior blunting as well as keratin pearl formation. When performed by an experienced surgeon, the results of lateral grafting are excellent. The technical considerations that promote successful lateral grafting are highlighted in this video.

Neonatal Mandibular Distraction Osteogenesis with Multivector External Devices

Pierre Robin sequence (PRS) is a craniofacial malformation characterized by micrognathia and glossoptosis, with or without cleft palate. A subset of infants with PRS will suffer from airway obstruction severe enough to merit surgical intervention. Surgeries for PRS include tongue lip adhesion, tracheotomy, gastrostomy, and bilateral mandibular distraction osteogenesis. Distraction osteogenesis refers to a process in which a bone is lengthened after an initial osteotomy by means of separating the two resulting segments slowly over time. In the neonatal mandible, hardware used for distraction may be implanted beneath the skin or affixed externally. Each device has its advantages and disadvantages, however external devices are less expensive, do not typically require preoperative computed tomography scanning, may be adjusted easily throughout the distraction process, and are easily removed following consolidation, avoiding a second invasive procedure and lengthy anesthetic. This video presents the technique of neonatal mandibular distraction osteogenesis using multivector external distractors.

Grade 1 Microtia Repair Using Autologous Auricular Cartilage Transfer

The goal of auricular reconstruction is to achieve a natural appearance of the reconstructed side with a form that resembles the normal ear and endures over a lifetime. For severe deformities in which major cartilaginous elements are missing, established reconstructive techniques using alloplastic constructs wrapped in temporoparietal fascia or carved costal cartilage grafts may be employed. For cases of minor deformity in which all named cartilaginous components are present, albeit deficient compared to the normal side, transfer of autologous auricular skin and cartilage may be used to achieve symmetry between normal and abnormal ears. This video presents the surgical technique and results of a grade 1 microtia reconstruction using autologous auricular cartilage transfer. This two-stage method of reconstruction avoids the use of autologous rib or alloplastic materials and often avoids the use of skin grafting altogether.

Middle Fossa Approach for Vestibular Schwannoma (Acoustic Neuroma) Resection

This video demonstrates the operative setup and surgical steps of a middle fossa approach for the resection of vestibular schwannoma (acoustic neuroma). Authors: Cameron C. Wick, MD (cameron.wick@wustl.edu) 1 Samuel L. Barnett, MD (sam.barnett@utsouthwestern.edu) 2 J. Walter Kutz Jr., MD (walter.kutz@utsouthwestern.edu) 3 Brandon Isaacson, MD (brandon.isaacson@utsouthwestern.edu) 3 1 - Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 2 - Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX 3- Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX

Excision of Macrocystic Lymphatic Malformation

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.

Use of CO2 Flexible Fiber Laser in Lyses of Middle Ear Adhesions

This video demonstrates the use of CO2 flexible fiber laser for the lyses of middle ear adhesions in a patient s/p canal wall down mastoidectomy.

Endoscopic Grade 4 Subglottic Stenosis

We describe the management of a grade 4 subglottic stenosis, which was successfully performed endoscopically. This is the case of a 17 year-old female, tracheostomy dependent, with a complex history of failed open airway surgeries. Patient was referred to our center for a second opinion for decannulation. We found a grade 4 subglottic stenosis at her initial evaluation with a prolapsed anterior graft. Patient and family requested an endoscopic procedure, trying to avoid another open surgery. It was decided that an endoscopic procedure would be attempted. Patient was placed into suspension, and using alligator forceps, the stenotic area was probed until communication could be made with the distal tracheal. Using a series of balloon dilations and the microdebrider, a suprastomal stent could be endoscopically placed. Stent was removed 6 weeks later and showed a patent airway. Patient then underwent a series of 4 dilations and was successfully decannulated, just before graduating from college.

Endoscopic Repair of Type IIIB Posterior Laryngeal Cleft

We present a case of a type IIIB posterior laryngeal cleft treated successfully with endoscopic repair.

Excision of Lymphatic Malformation of Tongue

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.

Submental Intubation

Presented is a case of submental intubation performed prior to maxillomandibular advancement for the treatment of obstructive sleep apnea. Submental intubation is a viable alternative to tracheostomy for cases in which nasal intubation is contraindicated (e.g. trauma), or uninterrupted access to the oral cavity is preferred. [1] Briefly, the technique consists of performing oral intubation, and then exteriorizing the endotracheal tube through a tract created from the floor of mouth to the submental triangle. At the end of the case, the tube can be passed into the oral cavity, returning to an oral intubation. Surgeon: Raj C. Dedhia, MD, MSCR, Department of Otolaryngology, Emory University School of Medicine Video Production: Clara Lee, MS4, Emory University School of Medicine

Endoscopic Ossiculoplasty (TORP) with Prolapsed Facial Nerve

This video illustrates an endoscopic ossiculoplasty using a total ossicular replacement prosthesis (TORP) in a patient with a mixed hearing loss and a large conductive component. The video highlights the middle ear anatomy including a dehiscent and prolapsed facial nerve partially obstructing the oval window. Technical pearls for the ossiculoplasty are also highlighted. Cameron C. Wick, MD Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA cameron.wick@wustl.edu J. Walter Kutz Jr., MD Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA walter.kutz@utsouthwestern.edu

Upper Eyelid Blepharoplasty

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

Extended Partial Cricotracheal resection with thyrotracheal anastomosis in Grade IV subglottic stenosis with posterior glottic involvement

The video goes over the steps of an extended partial Cricotracheal resection in a 8 year old child with Grade 4 subglottic stenosis with posterior glottis involvement.

Management of subglottic stenosis with endoscopic stent placement

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.

Congenital Cholesteatoma - Endaural Approach Tympanoplasty

N/A

Retroseptal Transconjunctival Approach to Orbital Floor Blowout Fracture

The transconjunctival approach was first described by Bourquet in 1924 and then modified by Tessier in 1973 for exposure of the orbital floor and maxilla for the treatment of facial trauma. This approach can be carried out either in a preseptal plane by separating the orbital septum from within the eyelid (preseptal approach) or posterior to the septum and eyelid (retroseptal approach) by making an incision through the bulbar conjunctiva directly above the orbital rim. The main advantage of the retroseptal approach is that it does not involve dissection and disruption of the eyelid itself, therefore, reducing the incidence of post-operative lid laxity and position abnormalities. This video will show a retroseptal approach to an orbital floor blowout fracture. A lateral inferior cantholysis is performed to facilitate eversion and retraction of the lower eyelid.

Endoscopic Stapedotomy

Endoscopic ear surgery is an emerging technique championed for its improved visualization within the middle ear space. Stapes surgery presents a unique endoscopic challenge in that it offers a different type of depth perception compared to the binocular microscopic view. This video highlights the surgical steps for an endoscopic stapedotomy using a CO2 laser and Eclipse nitinol piston. The stapes footplate and stapedotomy are well visualized with the endoscope. Just like in endoscopic sinus surgery, depth perception is achieved through muscle-memory and camera movement. Author: Cameron C. Wick, MD Institution: Department of Otolaryngology - Head and Neck, Washington University School of Medicine in St. Louis, St. Louis, MO, USA Email: cameron.wick@wustl.edu

Internal Nasal Valve Stabilization

Dynamic internal nasal valve collapse is common form of nasal valve collapse that can be difficult to address surgically. There have been many surgical techniques described to stabilize and improve the function of the internal nasal valve. Our presented technique is a simple and reproducible surgical technique that has proved reliable in treatment of dynamic internal nasal valve collapse. This video clearly describes and demonstrates our internal nasal valve stabilization technique.

Excision of a Preauricular Cyst

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.

How to Perform Salivary Gland Massage: Instructional Video

Title: How to perform a salivary gland massage - an instructional video Delaney Sheehan, MS; David Thompson, MS; Brittany Foret, MS; Michael Olejniczak, MS; Rohan R. Walvekar, MD* *Corresponding and Senior Author MS - Medical Student Louisiana State University Health Sciences Center, Department of Otolaryngology Head & Neck Surgery, New Orleans, LA 70112 Introduction: Education is a vital component to patient compliance. Salivary gland conditions like sialadenitis, dry mouth and postoperative protocols for sialendoscopy procedures among other procedures on the salivary glands often require a protocol of salivary gland massage; which forms a vital part of salivary gland hygiene i.e. salivary gland massage, hydration and sialogogues. In our search, we did not find a specific educational video demonstrating salivary gland massage. Funding: No external funding. Methods: The Ear Nose and Throat Interest Group at Louisiana State University Health Sciences Center in New Orleans under the supervision of senior author compiled the patient education and instructional video. Summary: Educational video on salivary gland massage is a way to disseminate a resource that can be easily accessed by patients and can be helpful in standardizing technique and also compliance.

Primary Repair of Unilateral Complete Cleft Lip and Nose Deformities

The following video demonstrates the author's method for repairing wide unilateral complete cleft lip and cleft nasal deformities. Details of surgical markings as well as nuances of technique are demonstrated. Video documentation of immediate results as well as progress of healing over the following year are included.

Transoral incision and drainage of retropharyngeal abscess.

Authors: Matthew Kim, Vikash Modi. This is a demonstration of transoral incision and drainage of retropharyngeal abscess in a 5-year-old male who presented with fever and neck stiffness. An initial CT scan with intravenous contrast showed retropharyngeal edema without organized abscess. A repeat scan 4 days later revealed a peripherally enhancing, multi-loculated hypodense collection centered in the left retropharyngeal space. After induction of general anesthesia and orotracheal intubation with a 4.5 cuffed oral RAE endotracheal tube, the patient is placed in suspension with a Crowe-Davis mouth gag. The abscess forms a noticeable bulge in the posterior pharyngeal wall. A flexible suction catheter is passed through the right nasal cavity and used to retract the soft palate and uvula to maximize exposure. After retracting the tonsillar pillars laterally with a Hurd elevator, a Beaver 6400 mini blade is used to make a vertical incision in the pharyngeal mucosa centered over the abscess. There is immediate return of purulence – a culture swab is used to obtain a sample for microbiological testing. A Yankauer suction bluntly enlarges the opening while simultaneously suctioning out purulent debris. The incision is widened superiorly and inferiorly with curved Metzenbaum scissors. Spreading the instrument vertically minimizes risk of vascular injury. An Adson clamp is then used to bluntly explore the abscess cavity laterally and superiorly. Further purulent drainage is expressed. The abscess cavity is further explored and widened with digital dissection. The abscess cavity is copiously irrigated with saline. After confirming hemostasis, the patient was extubated uneventfully. He was started on an oral diet immediately after surgery and discharged the following day.

Robotic-assisted Base of Tongue Resection for Adult Sleep Apnea

A 52-year-old female presented for an evaluation for sleep apnea surgery. She complained of choking sensation at night. She had an AHI of 6.7 events per hour, a oxygen saturation nadir of 71%, and BMI of 30.6. She and a prior history of adenotonsillectomy as a child. Flexible examination in the office revealed grade 4 lingual tonsil hypertrophy. She was deemed a candidate for lingual tonsillectomy and was taken to the operating for robotic lingual tonsillectomy. The technique for adult lingual tonsillectomy is shown in step-by-step fashion with tips for good results both operatively and functionally learned from robotic surgery for cancer of the unknown primary origin. Contributors: Jessica Moskovitz, MD, Leila J. Mady, MD, PhD, MPH, Umamaheswar Duvvuri, MD, PhD

Pediatric Tracheostomy

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.

Endoscopic Sphenopalatine Artery Ligation

A 58-year-old female on Plavix presented to the ER with recurrent left-sided epistaxis after two prior endoscopic control of epistaxis at an outside hospital. The patient’s hemoglobin and hematocrit at presentation were 8.3 gm/dL and 25.4%. Given the unilateral presentation, antiplatelet therapy, and recently failed endoscopic control, the patient was taken to the operating room for transnasal endoscopic sphenopalatine artery ligation (TESPAL) with bipolar cautery. Contributors: Mathew Geltzeiler and Eric Wang

A Guide to Temporal Bone Dissection: Cortical Mastoidectomy & Facial Recess Approach (Part 1 of 6)

Authors Mohamedkazim M. Alwani, MD1, 3 Jon L. Harper, BS1, 3 Rick F. Nelson, MD PhD1, 2, 3 Author Affiliations Department of Otolaryngology – Head and Neck Surgery1 Department of Neurological Surgery2 Indiana University School of Medicine3 Description This video covers the key steps of a cortical mastoidectomy and facial recess approach during lab dissection of the temporal bone. The goal of this video is to serve as a supplementary teaching resource for resident-level surgical trainees by demonstrating key surgical landmarks and proper lab dissection technique. The first part of this video demonstrates a basic cortical mastoidectomy and focuses on fundamental principles including the preservation of the tegmen and sigmoid plate, adequate posterior canal wall thinning, continual saucerization, adequate removal of air cells, and early identification of the lateral semicircular canal and incus. The second part of the video discusses the facial recess approach and enlightens the viewer on the boundaries of the facial recess, the course of the mastoid segment of the facial nerve, and the location of the round window. Key surgical landmarks demonstrated in the course of this video include: zygomatic root, temporal line, posterior meatal wall, Henle’s spine, mastoid tip, tegmen mastoideum, sigmoid sinus, Koerner’s septum, lateral semicircular canal, incus, incus buttress, chorda tympani nerve, mastoid segment of the facial nerve, facial recess, round window niche, and round window.

A Guide to Temporal Bone Dissection: Endolymphatic Sac Dissection (Part 2 of 6)

Authors Mohamedkazim M. Alwani, MD1, 3 Jon L. Harper, BS1, 3 Rick F. Nelson, MD PhD1, 2, 3 Author Affiliations Department of Otolaryngology – Head and Neck Surgery1 Department of Neurological Surgery2 Indiana University School of Medicine3 Video Description This video shows the key steps in the dissection of the endolymphatic sac during lab dissection of the temporal bone. The goal of this video is to serve as a supplementary teaching resource for resident-level surgical trainees by demonstrating key surgical landmarks and proper lab dissection technique. This video builds on part one of our video series and demonstrates fundamentals of endolymphatic surgery including the location and appearance of the endolymphatic sac, and its relationship to the labyrinth. Key surgical landmarks demonstrated in the course of this video include: sigmoid sinus, mastoid segment of the facial nerve, retrofacial air cells, endolymphatic sac, lateral and posterior semicircular canal, and Donaldson’s line

A Guide to Temporal Bone Dissection: Lateral Temporal Bone Resection (Part 3 of 6)

Authors Mohamedkazim M. Alwani, MD1, 3 Jon L. Harper, BS1, 3 Rick F. Nelson, MD PhD1, 2, 3 Author Affiliations Department of Otolaryngology – Head and Neck Surgery1 Department of Neurological Surgery2 Indiana University School of Medicine3 Video Description This video covers the key steps of a lateral temporal bone resection during lab dissection of the temporal bone. The goal of this video is to serve as a supplementary teaching resource for resident-level surgical trainees by demonstrating key surgical landmarks and proper lab dissection technique. This video builds on part two of our video series. This approach allows for the en bloc removal of the external auditory canal and demonstrates fundamental steps of the procedure including: the propagation of a superior trough between the tegmen and the superior aspect of the external auditory canal, the extension of the facial recess inferiorly with sacrifice of the chorda tympani, and the drilling of the hypotympanic bone towards the glenoid. At the completion of the demonstration, the viewer is afforded a labelled view of the medial wall of the mesotympanum, as well as the medial aspect of the external auditory canal with an intact tympanic membrane. Key surgical landmarks demonstrated in the course of this video include: tegmen, zygomatic root, malleus, incus, stapes, glenoid, eustachian tube, mastoid segment of the facial nerve, chorda tympani nerve, facial recess, hypotympanic space, annular bone, tensor tympani tendon, cochlear promontory, pyramidal process, round window, and lateral semicircular canal.

A Guide to Temporal Bone Dissection: Labyrinthectomy (Part 4 of 6)

Authors Mohamedkazim M. Alwani, MD1, 3 Jon L. Harper, BS1, 3 Rick F. Nelson, MD PhD1, 2, 3 Author Affiliations Department of Otolaryngology – Head and Neck Surgery1 Department of Neurological Surgery2 Indiana University School of Medicine3 Video Description This video demonstrates the key steps of a labyrinthectomy during lab dissection of the temporal bone. The goal of this video is to serve as a supplementary teaching resource for resident-level surgical trainees by demonstrating key surgical landmarks and proper lab dissection technique. This video builds on part three of our video series and demonstrates fundamental steps involved in a labyrinthectomy including: the identification of the three-dimensional (3D) orientation of the semicircular canals, the location of the common crus, the relationship between the second genu of the facial nerve and the posterior semicircular canal, the relationship of the vestibule to the endolymphatic sac, the course of the subarcuate artery, and the relationship of the labyrinth to the internal auditory canal. Key surgical landmarks demonstrated in the course of this video include: posterior semicircular canal, superior semicircular canal, lateral semicircular canal, common crus, external genu of facial nerve, tympanic segment of the facial nerve, tegmen, vestibule, endolymphatic sac, endolymphatic duct, subarcuate artery.

A Guide to Temporal Bone Dissection: Internal Auditory Canal Dissection (Part 5 of 6)

Authors Mohamedkazim M. Alwani, MD1, 3 Jon L. Harper, BS1, 3 Rick F. Nelson, MD PhD1, 2, 3 Author Affiliations Department of Otolaryngology – Head and Neck Surgery1 Department of Neurological Surgery2 Indiana University School of Medicine3 Video Description This video demonstrates key steps in the dissection of the internal auditory canal during lab dissection of the temporal bone. The goal of this video is to serve as a supplementary teaching resource for resident-level surgical trainees by demonstrating key surgical landmarks and proper lab dissection technique. This video builds on part four of our video series and demonstrates fundamental steps involved in the dissection of the internal auditory canal including: establishing an inferior trough and identification of the cochlear aqueduct, establishing a superior trough and identification of the labyrinthine segment of the facial nerve, and blue-lining the internal auditory canal from porous to fundus. Key surgical landmarks demonstrated in the course of this video include: internal auditory canal, cochlear aqueduct, meatal segment of the facial nerve, labyrinthine segment of the facial nerve, 1st genu of the facial nerve, tympanic segment of the facial nerve, 2nd genu of the facial nerve, mastoid segment of the facial nerve.

A Guide to Temporal Bone Dissection: Infratemporal Approach (Part 6 of 6)

Authors Mohamedkazim M. Alwani, MD1, 3 Jon L. Harper, BS1, 3 Rick F. Nelson, MD PhD1, 2, 3 Author Affiliations Department of Otolaryngology – Head and Neck Surgery1 Department of Neurological Surgery2 Indiana University School of Medicine3 Video Description This video demonstrates key steps in the infratemporal approach during lab dissection of the temporal bone. The goal of this video is to serve as a supplementary teaching resource for resident-level surgical trainees by demonstrating key surgical landmarks and proper lab dissection technique. This video builds on part five of our video series and demonstrates fundamental steps of the procedure including: decompression and mobilization of the facial nerve, dissection of the cochlear scalae, skeletonization of the carotid artery, and entry into the jugular bulb. We demonstrate the wide opening of the jugular bulb to facilitate visualization of the medial wall of the jugular bulb, which subsequently aids in the dissection of the pars nervosa. Key surgical landmarks demonstrated in the course of this video include: sigmoid sinus, jugular bulb, mastoid segment of the facial nerve, cochlear scalae, internal carotid artery, pars nervosa

Inferior Turbinate Trim

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

Excision of Thyroglossal Duct Cyst (Sistrunk Procedure)

This video demonstrates an excision of a thyroglossal duct cyst with special focus on 1) using the thyrohyoid membrane as a landmark and 2) dissection of the posterior hyoid space, which is the space between the thyrohyoid membrane and the posterior surface of the hyoid bone. Contributors: John Maddalozzo MD, FAAP, FACS; Monica Herron, MPAS, PA-C; Sarah Maurrasse, MD; Jesse Arseneau (editor) Ann & Robert H. Lurie Children's Hospital of Chicago

Saccular Cyst Marsupialization and Ventriculotomy

We present a case of a saccular cyst managed initially with marsupialization followed by ventriculotomy for recurrence.

Transoral Robotic Surgery (TORS) Excision of a Base of Tongue Venolymphatic Malformation in a Pediatric Patient

This video demonstrates successful Transoral Robotic Surgery (TORS) excision of a large, midline, base of tongue venolymphatic malformation after pre-operative embolization in a 6-year-old boy.

Microlaryngoscopy, Bronchoscopy + Supraglottoplasty in COVID-19 Era

This video demonstrates microlaryngoscopy, bronchoscopy (MLB) + supraglottoplasty in a three-month old male with laryngomalacia, with a special focus on appropriate personal protection equipment (PPE) and safe surgical considerations in the setting of a COVID-19 status unknown patient.

Treatment of Chronic Atelectatic Middle Ear with Endoscopic Placement of Cartilage Shield T-tube

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.

Zenker's Diverticulotomy

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

Preauricular Pit/Cyst Excision

This video demonstrates the excision of a preauricular pit/cyst in a pediatric patient. John Maddalozzo, MD Sarah Maurrasse, MD Johanna Wickemeyer, MD Sneha Giri, MD Division of Pediatric Otolaryngology-Head & Neck Surgery Ann & Robert H. Lurie Children's Hospital of Chicago

Right Sided Hemithyroidectomy for Benign Multinodular Goiter

Author: Joshua Hagood Performing surgeon/coauthor: Brendan C. Stack, Jr., M.D., FACS, FACE Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA

Closure of H-type tracheoesophageal fistula

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.

Endoscopic resection of a vallecular cyst in a pediatric patient

Base of tongue masses are rare in the pediatric population, when present they can be remain asymptomatic for years or can cause acute respiratory distress. The differential diagnosis includes dermoid, vallecular cyst, thyroglossal duct cyst, lingual thyroid, lymphangioma, hemangioma, and teratoma (1). Vallecular cysts consist of mucus filled cysts or pseudocysts arising either from the mucosa on the lingual surface of the epiglottis or on the base of tongue (2). These benign mucous retention cysts most commonly present as stridor, difficulty feeding, respiratory distress but they can also remain asymptomatic and can be found incidentally (3,4). Vallecular cysts may occur in isolation, but they can be associated with laryngomalacia and GERD in a significant number of patients(5). Initial screening of the airway is done using flexible fiberoptic laryngoscopy which provides a quick assessment of the larynx and visualization of the cyst(6). Imaging (ultrasonography, CT, MRI) can also be useful for evaluation of the mass and more detailed visualization of the mass and surrounding structures(6). Conservative medical treatment is not adequate for the management of vallecular cysts. Several surgical options have been described, these include aspiration, transoral endoscopic excision, marsupialization and deroofing with CO2 laser or microdebrider (6). There is a high recurrence rate when simple aspiration is performed (7), and there is reported risk of recurrence with marsupialization techniques. Excision using transoral endoscopic technique ensures complete resection with adequate visualization and preservation of surrounding structures and mucosa with low risk of recurrence (4). Here, we describe transoral endoscopic approach for excision of base of tongue cyst in a 3 year-old female. The patient presented with the diagnosis of PFAPA and she was seen to discuss tonsillectomy and adenoidectomy. On physical exam, a 1.5 cm midline base of tongue cyst was seen when she protruded her tongue. The cyst had been increasing in size. Plan was to proceed with tonsillectomy & adenoidectomy and excision of base of tongue cyst. After informed consent was obtained, the patient was brought to the operating room and placed supine on the operating table. Correct patient and procedure were identified and general anesthesia by mask was induced. A laryngeal mask airway was placed first. A red rubber catheter was placed through the left nostril after the Davis mouth gag was inserted with a small tongue blade. The soft palate and uvula were palpated to be normal. The adenoid was mildly enlarged and was cauterized completely with suction cautery. Following that, Afrin was placed in the nasal cavity. The child was intubated with a nasotracheal tube through her left nostril that allowed for exposure. A red rubber catheter was left in her right nostril. The side-biting mouth gag was used. Two separate 2-0 silk sutures were placed in the midline to retract her tongue. A 30-degree telescope was used for visualization of the base of tongue cyst. With the Hurd elevator and other means of retraction, an extended Colorado needle tip with a 45 degree bend at the distal portion, was used to completely remove the base of tongue cyst which was quite deep. At the distal part, there was mucus seen, but the cyst was completely excised. The wound was irrigated thoroughly. There was no bleeding. The side-biting mouth gag was removed and the Davis mouth gag reinserted. A complete tonsillectomy was then performed. She was then extubated without difficulty in the OR and transferred to PACU. Patient was discharged on oxycodone and amoxicillin. On her follow up visits, the oral cavity and tongue were healing well with no evidence of recurrence. Pathology result: consistent with extravasation mucocele. Mucin filled cystic space rimmed by a lympho-histiocytic reaction and granulation tissue. Minor salivary glands w/ dilated ducts focally surrounded by chronic inflammation are present in the surrounding fibromuscular tissue.

Endoscopic Stapedotomy (2:55)

Stapedotomy is used to treat conductive hearing loss caused by a fixed stapes footplate. The procedure is traditionally performed via a surgical microscope. In recent years an endoscopic approach has been increasingly utilized due to several advantages that it offers over the microscopic approach, chiefly the excellent visualization of middle ear structures provided by the endoscope. In this video we describe our technique for stapedotomy via an endoscopic approach.   This surgery was performed by James Prueter, DO, of Southwest Ohio ENT Specialists in Dayton, OH.   Video editing was performed by Wesley Greene, MS-4 Wright State University Boonshoft School of Medicine with assistance from Britney Scott, DO, PGY-3 Kettering Health Network Otolaryngology Surgery.

Endoscopic Tympanoplasty with Tragal Cartilage Graft in a Pediatric Patient (3:54)

Tympanoplasty is used to repair persistent perforations of the tympanic membrane. The procedure has traditionally been performed via a surgical microscope. In recent years an endoscopic approach has been increasingly used due to several advantages that it offers over the microscopic approach, chiefly the excellent visualization of middle ear structures provided by the endoscope. In this video we describe our technique for endoscopic tympanoplasty using a tragal cartilage graft in a pediatric patient.   This surgery was performed by James Prueter, DO, of Southwest Ohio ENT Specialists in Dayton, OH.   Video editing was performed by Wesley Greene, MS-4 Wright State University Boonshoft School of Medicine with assistance from Britney Scott, DO, PGY-3 Kettering Health Network Otolaryngology Surgery.

How to perform a Tracheostomy on an infant

Authors Gilberto Eduardo Marrugo Pardo Titular professor, Department of Otorhinolaryngology, Universidad Nacional de Colombia, Bogotá, Colombia. Fundación hospital de la misericordia. gemarrugop@unal.edu.co JuanSebastián Parra Charris Department of Otorhinolaryngology, Universidad Nacional de Colombia, Bogotá, Colombia jusparrach@unal.edu.co    

Base of Tongue Reduction: Endoscopic Approach vs. Transoral Robotic Surgical Approach

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.

Lip Pit Excision

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.

Non-surgical management: Taping of the Lop Ear

Lop ear is a type of congenital external ear deformation with folding over of the upper third of the ear. Children are often bullied for these noticeable anomalies. Successful management depends on early initiation and parental persistence. We present a nonsurgical, easily replicable and cost-effective method using a dental wax splint secured with steri-strips. This video can be used as an adjunct for telehealth appointments in parent education to reduce delay in treatment and to promote therapy maintenance.

Reconstruction of Transcribriform Skull Base Defects

A 51 year-old male presented to an outside otolaryngologist with recurrent facial pain and congestion. He was found to have a left-sided nasal mass. A work-up was performed, complete with biopsy, which was diagnosed as non-intestinal type adenocarcinoma. He underwent resection via the endoscopic endonasal transcribriform approach. In this video publication, we present our preferred method of reconstruction for sinonasal malignancies treated by endoscopic transcribriform resection using a multilayered closure with the following: a subdural DuraGen inlay graft, a fascia lata onlay graft, and an extradural, extracranial onlay pericranial flap via nasionectomy. A lumbar drain was placed at the end of the case for CSF diversion until the fifth postoperative day. Contributors: Paul A. Gardner, MD, Eric W. Wang, MD, Juan C. Fernandez-Miranda, MD, and Carl H. Snyderman, MD, MBA

Pediatric Tracheostomy with Maturation Sutures

Procedure: This video demonstrates the operative method of pediatric tracheostomy with maturation sutures of the tracheocutaneous fistula tract. Introduction: Pediatric tracheostomy provides an alternate airway. Indications: This procedure is done to alleviate upper airway obstruction, facilitate prolonged mechanical ventilation, or pulmonary toilet. Contraindications: There are no absolute contraindications to this procedure, however, like any procedure, it has recognized possible risks. Conclusion: Pediatric tracheostomy with maturation sutures provides an alternate airway to bypass obstruction, facilitate long term ventilation, or pulmonary toilet.

The Extended Nasoseptal Flap

A 31 year-old male presented with diplopia and was found to have left sixth nerve palsy on physical examination. Work-up with MRI revealed a hypointense mass on T2 images involving the mid to lower clivus with penetration of the posterior fossa dura. The patient had no complaints of nasal obstruction, no prior nasal surgery or nasal trauma. Intraoperative frozen section analysis revealed chordoma. Author Note: minute 3:41 "rostrum" was spelled incorrectly. Contributor: Eric Wang

Supraglottoplasty and Epiglottopexy for Sleep-Variant Laryngomalacia

Here we present a 6-year-old girl with sleep-variant laryngomalacia treated successfully with endoscopic epiglottopexy and supraglottoplasty. Johanna L. Wickemeyer, MD1 Sarah E. Maurrasse, MD2,3 Douglas R. Johnston, MD, FACS2,3 Dana M. Thompson, MD, MS, FACS2,3 1Department of Otolaryngology—Head & Neck Surgery, University of Illinois—Chicago, 1855 West Taylor Street, Chicago, IL 60612 2Division of Pediatric Otolaryngology—Head and Neck Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL 60611 3Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611

Surgical management of keratosis obturans

Keratosis obturans is a condition of the external auditory canal (EAC) characterised by formation and accumulation of desquamated keratin resulting in varying symptoms. Clinically presents as otalgia, conductive hearing loss and recurrent infection. Typically seen in younger age group and can occur bilaterally. Extension to adjacent structures can occur and result in further complications. The proposed theory is that there is a defect in epithelial in migration resulting in widening / osteitis of external canal bone. Condition was first described by Toynbee in 1850, and named by Wreden in 1874. Pipergerdes in 1980 distinguished keratosis obturans as separate disease from external auditory canal cholesteatoma. Ever since various treatment regime has been recommended but none of them have been curative. Michael M Paparella was first to propose surgical treatment in 1966 and he then modified the surgical technique in 1981. Because the defect is in epithelial migration, canaloplasty with or without graft, without obliterating the bony canal defect will not restore epithelial migration. Hence, M. M Paparella’s surgical technique was NOT popularized. Mr Basavaraj proposes novel technique which not only clears the diseased bone but obliterates the bony defect, and grafts the ear canal to bring it back to normal shape and size to encourage normal epithelial migration.

Total Facial Nerve Decompression via Combined Middle Cranial Fossa and Transmastoid approach

Authors: Gavriel D. Kohlberg, MD - University of Cincinnati Noga Lipschitz, MD - University of Cincinnati Charlie Poff, BS - Medical University of South Carolina Ravi N. Samy, MD, FACS - University of Cincinnati

Transoral Awake Potassium Titanyl Phosphate (KTP) Laser Treatment of Recurrent Respiratory Papillomatosis

This video demonstrates an awake transoral approach for laser ablation of recurrent respiratory papillomatosis. A side-channel flexible laryngoscope is introduced transorally until the laryngeal introitus is visualized and anesthetized. The laryngeal disease is then treated with the KTP laser.

Transpalatal Advancement Pharyngoplasty

The retropalatal airway is a common site of collapse in obstructive sleep apnea. Transpalatal advancement pharyngoplasty aims to address this site of upper airway collapse by advancing the soft palate anteriorly, increasing the cross-sectional area of the airway and decreasing pharyngeal collapsibility. Surgeon: Raj C. Dedhia1, MD, MSCR Video Production: Yifan Liu1,2, MD, Jason Yu1, MD 1 Perelman School of Medicine, Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania 2 Department of Otorhinolaryngology - Head and Neck, Affiliated Beijing Anzhen Hospital, Capital Medical University

Sphenopalatine Artery Ligation

A 70-year-old male presented with persistent left-sided epistaxis, occurring 4 - 12 times a day for 3 weeks. Episodes lasted 10 - 15 minutes, but once required nasal packing at the ED. Introduction: Ligation of the sphenopalatine artery is often indicated for patients with persistent posterior epistaxis that cannot be attributed to other causes. This video demonstrates a step-wise endoscopic sphenopalatine artery ligation using hemoclips. Methods: In order to access the maxillary sinus cavity, a ball-tip probe was used to fracture the uncinate and a backbiter was used to remove the uncinate in its entirety. Once in the maxillary sinus, a backbiter was used to remove the tissue anterior to the normal ostium. A straight Tru-Cut was used to remove tissue posterior the natural ostium, taking down the posterior fontanelle. After this was done, a down-biter and a microdebrider blade were used to remove tissue inferior to the natural ostium towards the inferior turbinate. A caudal instrument was used to raise a subperiosteal flap just posterior to the left maxillary sinus posterior wall. Next, dissection from the inferior turbinate up to the top of the maxillary sinus was done from an inferior to superior direction, roughly 1 cm posterior to the posterior wall of the maxillary sinus. The sphenopalatine artery was seen coming out of the sphenopalatine foramen and soft tissue was dissected off this artery. Two hemoclips were placed over the entire artery. Results: The patient was sent to recovery in good condition and no adverse reactions were reported by the surgeon or patient. Surgeons: Alissa Kanaan, MD. Zachary V. Anderson, MD. Institution: Department of Otolaryngology - Head and Neck Surgery at the University of Arkansas for Medical Sciences.

Type 1 Thyroplasty - Silastic

Type 1 thyroplasty is used to close glottic gaps due to an immobile or atrophied vocal fold. It is performed via an external approach with local anesthetic and the patient under monitored anesthesia care. Vocalization during implant carving and placement allows for "tuning" of the implant. Type 1 thyroplasty can be combined with arytenoid adduction if needed to close the posterior glottis.

Superficial Parotidectomy for a First Branchial Cleft Cyst

This video demonstrates a superficial parotidectomy approach for the excision of a first branchial cleft cyst in a pediatric patient. This particular patient was a 4-year-old girl who presented with intermittent swelling in the region of the left parotid. On MRI, she was found to have a lobular mass consistent with a first branchial cleft cyst. Here we outline the steps of the recommended surgical procedure. Authors: Sarah Maurrasse, MD1,2; Monica Herron, MPAS, PA-C1; John Maddalozzo MD, FAAP, FACS1,2 Editors: Sarah Maurrasse1,2; Jesse Arseneau1 Voiceover: Vidal Maurrasse 1Ann & Robert H. Lurie Children's Hospital of Chicago 2Northwestern University Feinberg School of Medicine

Successful Placement of Transcutaneous Bone Anchored Hearing Aid in a Pediatric Patient

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.

Endoscopic Repair of a Jugular Diverticulum

We present a case of a patient with a jugular diverticulum causing persistent pulsatile tinnitus which was successfully treated with a CO2 laser endoscopic procedure. To our knowledge this is the first instance of a dehiscent jugular diverticulum being successfully treated in this manner. We believe this procedure is advantageous when compared to other treatment modalities because it is 1) minimally invasive 2) there is decreased pain and recovery time compared to other surgical approaches and 3) the risk of serious post-op infection such as meningitis is theoretically much lower when compared to posterior auricular approaches that must expose the dura of the brain to reach the jugular diverticulum.

Transcervical Epiglottopexy for management of Type 3 Laryngomalacia

Type 3 Laryngomalacia (LM) is characterized by prolapse of the epiglottis into the airway. Endolaryngeal suturing is technically challenging considering the limited exposure. In the present article we describe a simple technique of Transcervical Epiglottopexy (TE) via an exo-endolaryngeal technique, using an 18-gauge needle prethreathed with a 2-0 prolene suture in a looped fashion inserted through the inferior epiglottis. Another 20 G needle with a 2-0 prolene suture, with one free end is inserted above the previous stitch through the superior epiglottis. The single stitch is passed through the looped stitch, which is then pulled through the neck, leaving a single stitch precisely placed through the epiglottis. We have used this technique safely while achieving epiglottopexy in 3 cases of epiglottic prolapse. We describe a method of Transcervical Epiglottopexy using easily available instruments. This method we believe can easily be adapted for any kind of epiglottic prolapse.

Endoscopic Frontal Sinusotomy with Osteoma Removal

A 49-year-old female presented with a one-year history of right frontal headaches, not controlled despite OTC medication. Work up with head CT revealed an osteoma of the right frontal sinus. The patient experienced no improvement in headache severity and elected to have surgical intervention. Methods: ENT Fusion Navigation system was used during the entire case. A ball-tip probe was used to fracture out the uncinate bone and a backbiter was used to remove the uncinate in its entirety. The natural ostium of the right maxillary sinus was then visualized. Again, the backbiter was used to remove tissue anterior to the natural ostium. A straight Tru-Cut was used to remove the ostium towards the posterior fontanelle. The right middle turbinate was resected in order to gain sufficient access for the resection of the osteoma. In order to remove the right middle turbinate, a turbinate scissors were used to make 3 cuts along the attachment of the middle turbinate and this was pulled down. A down biter was used to open up the maxillary sinus inferiorly. There was no tissue seen in the maxillary sinus. After this was done, an ethmoidectomy was performed by placing a J-curette behind the ethmoid bulla point anteriorly. This ethmoid bulla was removed along with several other anterior ethmoid cells. After this was done, a frontal sinus seeker was used to identify the right frontal osteoma. The patient did not have a right frontal sinus. Instead, an osteoma was in the area of what would have been the right frontal sinus or nasal frontal outflow tract. Image guidance was meticulously used to identify the osteoma. A 70-degree frontal drill was used and this osteoma was slowly drilled to remove as much as possible. Drilling was done from the posterior edge of the osteoma up to the skull base superiorly, to the lamina papyracea laterally and all bone that could be safely removed was removed. A right frontal propel stent was placed in the bony cavity created by the drill out and after this, the sinus was irrigated and suctioned. Results: The patient was sent to recovery in good condition and no adverse reactions were reported by the surgeon or patient. Surgeons: Alissa Kanaan, MD. Zachary V. Anderson, MD. Institution: Department of Otolaryngology - Head and Neck Surgery at the University of Arkansas for Medical Sciences.

Tongue Reduction (Partial Glossectomy) for Pediatric Macroglossia

This video demonstrates how to perform a tongue reduction using a Y-V advancement technique for pediatric macroglossia.

Myringotomy and Tympanostomy Tube (Ear Tube) Placement

This video demonstrates the required instruments, appropriate set-up, relevant anatomy, and procedural steps for ear tube placement. Sarah Maurrasse, MD; Erik Waldman, MD Yale School of Medicine, Yale New Haven Children's Hospital

Pediatric Laryngeal Reinnervation with Ansa Cervicalis to Recurrent Laryngeal Nerve Anastomosis

Unilateral vocal fold paralysis in children has many different etiologies that can result in difficulties with breathing, swallowing, or phonation. Depending on the severity of symptoms, treatment modalities range from non-surgical interventions, to temporary surgical procedures, or more permanent surgical options. Laryngeal reinnervation has been demonstrated as an appropriate treatment option for children with permanent laryngeal nerve damage and persistent symptoms, but it still not widely performed among pediatric otolaryngologists. In this case, we present a 6 year-old female patient who developed unilateral vocal fold paralysis from a cardiac procedure as an infant, and she subsequently underwent laryngeal reinnervation with ansa cervicalis-to-recurrent laryngeal nerve (ANSA-RLN) anastomosis. The patient tolerated the procedure well with no peri-operative complications and demonstrated symptomatic improvement in voice quality and swallowing at her 3 month follow-up appointment. The goal of this case is to demonstrate the steps of the laryngeal reinnervation procedure and acknowledge its importance as a treatment option for unilateral vocal fold paralysis in pediatric patients.

Authors:

Cori N Walker MD¹, Christopher Blake Sullivan MD¹, Sohit P Kanotra MD¹

Department of ¹Otolaryngology – Head and Neck Surgery

University of Iowa Hospitals and Clinics, Iowa City, IA, USA

Pre-operative marking for the Fisher technique in unilateral cleft lip repair

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.

Endoscopic Repair of Unilateral Choanal Atresia

This video provides background information regarding the diagnosis and management of choanal atresia and demonstrates the endoscopic repair of a unilateral choanal atresia. Authors: Alexander Moushey1; Kiley Trott, MD2; Sarah E. Maurrasse, MD2 Voiceover: Vidal Maurrasse 1Yale School of Medicine, New Haven, CT 2Department of Surgery, Section of Pediatric Otolaryngology, Yale School of Medicine, Yale New Haven Children’s Hospital

Single Stage Laryngotracheal Reconstruction with Anterior Cartilage Graft

Single Stage Laryngotracheal Reconstruction with Anterior Cartilage Graft Leandro Socolovsky BA1, Rhea Singh BS1, Rajanya S. Petersson MS, MD1,2 1Virginia Commonwealth University School of Medicine, Richmond, VA 2Children’s Hospital of Richmond at VCU, Richmond, VA Overview This is a case of a 3-year-old male, former preterm infant born at 24 weeks with a past medical history of bronchopulmonary dysplasia and tracheomalacia status post tracheostomy for ventilator dependence. He had also developed subglottic stenosis from prolonged intubation. The patient was decannulated with grade 1 subglottic stenosis, and initially did well. However, over several months, the stoma remained fairly patent, prompting repeat direct laryngoscopy and bronchoscopy now demonstrating low grade 2 subglottic stenosis. The decision was made to proceed with laryngotracheal reconstruction with anterior rib cartilage graft, expanding the airway size from a 3.5 uncuffed endotracheal tube (ETT) to a 5.0 uncuffed ETT. The patient was transferred to the ICU and kept intubated and sedated until extubation on post-operative day 3. At 6 weeks postoperatively, direct laryngoscopy showed a well-mucosalized graft, with the airway still sized to a 5.0 ETT. Procedure details Direct laryngoscopy and bronchoscopy on the day of the reconstruction confirmed low grade 2 subglottic stenosis. The patient was intubated with a size 3.5 cuffed ETT for the procedure. Right rib cartilage harvest was performed after the endoscopic airway evaluation, followed by carving of the cartilage graft on the back table. The cartilage was carved into a modified tear drop shape to accommodate the tracheal stoma, with a length of 25mm and a width of 7mm. The intraluminal depth of the graft was sized to the bevel of a 15-blade. A fusiform incision was marked around the previous tracheostomy site. Scar tissue was dissected until the previous tracheostomy tract was clearly visualized and then excised. Once the patent tracheostomy was seen, the trachea and thyroid cartilage were skeletonized superiorly until the thyroid notch was reached. An incision site was marked from the superior aspect of the tracheostomy to the inferior border of the thyroid cartilage to avoid the anterior commissure. The marked incision site was then measured for confirmation of adequate sizing of graft, and confirmed to be 25 mm. A 15-blade was used to make the incision into the airway. An oral RAE tube was trimmed and placed at the inferior aspect of the tracheal incision, after the ETT was backed out, and ventilation continued through the modified oral RAE. The incision was then advanced into the inferior 2mm of the thyroid cartilage without performing laryngofissure, ensuring not to go through the anterior commissure. The patient was nasotracheally intubated with a 5.0 uncuffed ETT in preparation for graft placement, and the modified oral RAE was removed. The nasotracheal tube was advanced just beyond the graft site. The cartilage graft was placed using 4-0 Vicryl pop-off sutures on RB-1 needles in simple interrupted fashion. The sutures were first placed into the graft through the extraluminal side and coming out at the junction of the intraluminal depth and cartilage that would overlap the airway. Then the sutures were placed submucosally through the cartilaginous rings of the trachea, taking care to avoid entering the airway lumen to prevent granulation tissue. A total of 8-12 sutures are typically placed, left untied, and tagged. The graft was then parachuted into position, and all sutures tied to ensure knots are squared. The wound was filled with saline, and a Valsalva at 20cm H2O was performed to ensure there was no air leak. The strap muscles were then loosely closed, and a split Penrose drain was placed with one limb under the strap muscles and the other subcutaneously. The skin was closed in layered fashion with 4-0 Monocryl deep inverted interrupted sutures and 5-0 Monocryl in a running subcuticular manner. The patient was kept intubated and sedated for 3 days per protocol for anterior graft at our institution. Extubation was performed in the pediatric intensive care unit on post-operative day 3. A bronchoscopy was performed through the nasotracheal tube, and the patient was extubated over the bronchoscope. The graft site was visualized on the way out, and noted to be intact, mucosalizing, and without granulation tissue.and ensure it is intact. Humidified support was given via a nasal cannula following extubation. At 6 weeks postoperatively a direct laryngoscopy was performed, noting well-mucosalized graft, and airway still sized to a 5.0 uncuffed ETT. Indications/contraindications for single stage anterior cartilage graft reconstruction Indications Subglottic stenosis (SGS); high grade 1 to grade 2 SGS, failed decannulation for lower grade SGS, suprastomal collapse Proximal tracheal stenosis Other potential indications for rib cartilage grafting (with or without posterior grafting): Glottic stenosis Tracheal stenosis Vocal cord paralysis Laryngeal web Relative Contraindications Ventilator dependence Acute upper or lower respiratory tract infection Untreated concurrent airway obstruction (vocal cord paralysis, tracheomalacia, bronchopulmonary dysplasia, adenotonsillar hypertrophy, choanal atresia) Congestive heart failure (>30% oxygen requirements, weight < 1500g) Instrumentation Setup Patient placed supine with shoulder roll with head facing the anesthesia team. The neck and right anterior chest are prepped and draped in sterile fashion. If tracheostomy tube is present, modified cut down oral RAE, is sewn to chest wall opposite the planned cartilage donor site The anesthesia circuit is placed under sterile drapes in a manner to allow access by the anesthesia team during the procedure Preoperative workup Endoscopic examination of supraglottis, glottis, subglottis, trachea, and bronchi to confirm location of obstruction or stenosis and identify any other lesions or airway concerns. True vocal fold mobility is assessed and palpation of cricoarytenoid joint is performed to determine integrity of posterior glottis. Laryngopharyngeal reflux control may be considered prior to surgery. Discussion and communication with anesthesiologist before, during, and after the case to ensure smooth transitions between airways and during transport to the PICU. Weighted nasogastric feeding tube, if not already present, should be placed prior to beginning procedure, especially if posterior graft is planned. Anatomy and Landmarks Strap musculature Hyoid bone Thyroid cartilage Cricoid cartilage Proximal trachea Advantages Single stage procedure does not require decannulation at later date. Single stage allows for reconstructing the potentially weak area of the anterior tracheal wall at the trach site itself. Disadvantages For single stage procedure patients must be intubated and sedated in an intensive care unit for graft stenting for an adequate period of time. This requires sedation and occasionally paralysis, depending on the patient. Typically, the intubation is 3 days at our institution, but can be up to 5 for anterior grafting. Complications/risks Bleeding, infection, reaction to anesthesia, abnormal scarring, granulation, need for further procedures Graft dislodgement or failure Need for tracheostomy Pneumonia Pneumothorax Vocal cord injury if laryngofissure is performed

Open Tracheotomy in Ventilated COVID-19 Patients

Authors Carol Li, MD1*, Apoorva T. Ramaswamy, MD1*, Sallie M. Long, MD 1 , Alexander Chern, MD 1 , Sei Chung, MD 1 , Brendon Stiles, MD 2 , Andrew B. Tassler, MD 1 1Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, NY 2Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY *Co-First authors Overview The COVID-19 pandemic is an unprecedented global healthcare emergency. The need for prolonged invasive ventilation is common amid this outbreak. Despite initial data suggesting high mortality rates among those requiring intubation, United States data suggests better outcomes for those requiring invasive ventilation. Thus, many of these patients requiring prolonged ventilation have become candidates for tracheotomy. Considered aerosol generating procedures (AGP), tracheotomies performed on COVID-19 patients theoretically put health care workers at high risk for contracting the virus. In this video, we present our institution’s multidisciplinary team-based methodology for the safe performance of tracheotomies on COVID-19 patients. During the month of April 2020, 32 tracheotomies were performed in this manner with no documented cases of COVID-19 transmission with nasopharyngeal swab and antibody testing among the surgical and anesthesia team. Procedure Details The patient is positioned with a shoulder roll to place the neck in extension. The neck is prepped and draped in a sterile fashion with a clear plastic drape across the jawline extending superiorly to cover the head. An institutional timeout is performed. The patient is pre-oxygenated on 100% FiO2. A 2-cm vertical incision is made extending inferiorly from the lower border of the palpated cricoid cartilage. Subcutaneous tissues and strap muscles are divided in the midline. When the thyroid isthmus is encountered, it is either retracted out of the field or divided using electrocautery. The remaining fascia is then cleared off the anterior face of the trachea. Prior to airway entry, the anesthesiologist pauses all ventilation and turns off oxygen flow. The endotracheal tube (ETT) is advanced distally past the planned tracheotomy incision, without deflating the cuff, if possible. If necessary, the endotracheal cuff is deflated partially to advance the tube, with immediate reinflation once in position. The surgical team then creates a tracheotomy using cold steel instruments. The cricoid hook is placed in the tracheotomy incision and retracted superiorly for exposure of the lumen. The tube is withdrawn under direct visual guidance, without deflating the endotracheal cuff if possible. The tracheotomy tube is placed, and to minimize aerosolization of respiratory secretions, the cuff is inflated prior to re-initiation of ventilation. The tracheotomy tube is then sewn to the skin using 2-0 prolene suture. A total of five simple stitches are placed around the tube to prevent accidental decannulation. Indications/Contraindications Candidacy for tracheotomy was determined on a case by case basis with consideration for progression of ventilator weaning, viral load, and overall prognosis. All patients who underwent tracheotomy were intubated prior to the surgery for a minimum of 14 days, able to tolerate a 90-second period of apnea without significant desaturation or hemodynamic instability, and expected to recover. Optimal ventilator settings included FiO2

Endoscopic Assisted Aural Atresia Repair

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.

Functional Endoscopic Sinus Surgery: Maxillary Antrostomy with Anterior Ethmoidectomy

This procedure was performed on a 6 year old male with chronic rhinosinusitis who had failed medical management and was subsequently found to have maxillary hypoplasia with computed tomography. Surgeon: Gresham T. Richter, M.D.

Radial Free Flap Dissection

Institution: University of Cincinnati Medical Center Authors: Yash Patil MD- patilyj@ucmail.uc.edu Arvind Badhey MD- badheyad@ucmail.uc.edu Siddhant Tripathi- tripatst@mail.uc.edu

Closed Nasal Reduction

Closed nasal reductions are the standard of care for displaced nasal bone fractures. Reduction should occur within 3 weeks of the initial injury, but after swelling has subsided. The success rate is 60-90% in uncomplicated cases, however 6-17% of patients will require a future septorhinoplasty. This procedure was performed under general anesthesia.

Flash Pulse Dye Laser (595nm) Therapy on Facial Capillary Malformation

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

Nasopharyngeal Papillomatosis- A combined Transnasal Transoral Coblation Assisted Approach

Title: Nasopharyngeal Papillomatosis- A combined trans nasal transoral coblation assisted approach Authors - 1. Dr Deepa Shivnani- corresponding author MBBS, DNB Otolaryngology , MNAMS, Fellowship in Pediatric Otolaryngology Children’s Airway & Swallowing Center Manipal Hospital, Bangalore , India email- deepa.shivnani14@gmail.com 2. Dr E V Raman MBBS, DLO , MS Otorhinolaryngology Children’s Airway & Swallowing Center Manipal Hospital, Bangalore Here I am presenting a case of 16 yrs old boy, who had nasal block and occasional cough. Nasal endoscopy revealed an exophytic papillomatous growth in the nasopharynx. MRI showed lesion arising from the nasopharyngeal surface of the soft palate. The lesion was free from the posterior pharyngeal wall. The patient was taken up for the procedure under general anaesthesia. The transoral approach was followed first. The tissue was taken for histopathological examination followed by a traction suture placed over uvula for better visualisation. Once exposed, coblation device was used transorally with 45 degree hopkins rod transorally. The tissue was ablated with coblation and coagulation settings of 9:5 respectively. The base was ablated too, to prevent further recurrence. Tonsillar pillar retractor was then used for better visualisation and exposure. The coblation was then continued. The tissue was removed transorally as much as possible then trans nasal approach was performed. Then, the same coblation device with the same setting was used but the nasal endoscope was changed to O degree Pediatric scope due to space constraints. The lesion was pushed upward with the help of yankaurs suction tip for better exposure and the remaining tissue was removed with the help of same coblation device. The lesion was excised completely and successfully with minimal blood loss. The operative area was confirmed with the 70Degree hopkins rod for complete removal of the lesion. Post operative recovery was uneventful. Combined transoral trans nasal coblation assisted approach is potential to be safer, easier and less invasive than uvulo palato pharyngoplasty in Pediatric age group specially, in the areas which are difficult to access like nasopharyngeal surface of the soft palate what we showed in this video.

Transoral Incision and Drainage of a Massive Retropharyngeal Abscess Involving the Danger Space

Retropharyngeal (RP) abscesses are uncommon yet serious sequala of pediatric head and neck infections. The RP space extends from the skull-base to the carina and is located between the buccopharyngeal fascia, alar fascia, and the carotid sheaths. Immediately deep to this, anterior to the prevertebral fascia, is the “danger space,” allowing infection to spread into the thorax and mediastinum. We present the use of a transoral incision, and suction assisted evacuation for managing a massive RPA with danger space extension. Our patient, a 19 months-old previously healthy female, presented with 10 days of progressive congestion, cough, and fever. Evaluation demonstrated a toxic stridorous child. Chest radiograph demonstrated significant superior mediastinal widening. Subsequent contrasted CT imaging demonstrated a large, rim-enhancing, RP fluid collection extending from the neck to the carina with tracheoesophageal compression and mediastinitis. The patient was taken urgently the OR for drainage. Following bronchoscopy and intubation, a mouth gag was used to expose the RP. Parasagittal incision was made with immediate expression of high volume purulent material. Hemostat dissection was performed to disrupt loculations and extrinsic neck compression was used to evacuate the abscess. To access the deepest components, an eight French tracheal suction catheter was passed to assist with decompression of the mediastinal components until no further material could be evacuated. Copious irrigation was performed and the incision was left open. The patient was kept intubated for 48 hours, before uneventful extubation.

Incomplete Cleft Palate Repair: Von Langenbeck Converted to Two-flap Palatoplasty with Furlow Double Opposing Z-Plasty

Title: Incomplete Cleft Palate Repair: Von Langenbeck Converted to Two-flap Palatoplasty with Furlow Double Opposing Z-Plasty Authors: Nima Vahidi, MD1; Nilan Vaghjiani, BS1; Rajanya Petersson, MS, MD1,2 1Virginia Commonwealth University School of Medicine, Richmond, VA 2Children Hospital of Richmond at VCU, Richmond, VA Overview: 10-month-old male with 18q deletion syndrome, Pierre Robin sequence (cleft palate, glossoptosis, and micrognathia), eustachian tube dysfunction, cardiac disease including ASD, VSD and WPW, pulmonary hypertension, as well as tracheostomy and G-tube dependence. In preoperative evaluation he was noted to have an incomplete cleft palate involving the hard and soft palate. He was noted to have bilateral eustachian tube dysfunction with effusions present. After discussion with family decision was made to proceed with surgical intervention.

Fibula Free Flap Harvest

We present the harvest of a osteocutaneous fibula free flap for head and neck reconstruction performed at the University of Cincinnati. This reconstructive technique has a wide variety of implications but has found greatest utility in the reconstruction of mandibular defects.

CAC (Coblation Assisted Cordectomy) in Bilateral Vocal Cord Palsy- Tips & Tricks

CAC (Coblation Assisted Cordectomy) in Bilateral Vocal Cord Palsy –tips & tricks Here, we have a 39 yrs old female with complaints of noisy breathing for last two years post thyroidectomy. Flexible laryngoscopy confirmed bilateral vocal cord paralysis. She was planned for coblation assisted cordectomy. Patient was taken up for procedure under general anaesthesia. She also started having stridor after induction. Nasopharyngeal intubation with spontaneous breathing technique was used. Entropy leads were placed over forehead to monitor the depth of anaesthesia. Tube position was confirmed with endoscopic view and Benjamin lindohlm laryngoscope was suspended. As the patient was spontaneously breathing, the stridor became more prominent, with stable vitals and the procedure was continued. The vocal cord retractor was fixed and coblation wand was then used with 7:3 settings for ablation and coagulation respectively. The surgical limits were-anteriorly the junction between ant 2/3 and post 1/3 of the vocal cord, posteriorly just anterior to the vocal process of arytenoid to prevent cartilage exposure and post operative granulations. Superely till the ventricle and inferioly till the medial most surface of the subglottis. Laterally approx. 5 mm depth was defined to prevent injury to the superior laryngeal artery branch and further bleeding. Once the final airway was achieved , the topical lignocaine was used to prevent laryngeal spasm post extubation. The patient was shifted to the ward without oxygen, the voice was assessed on post op day 2. Patient was called for follow up on post op day 14th and good voice outcomes were achieved. So lets have a look on some tips & tricks for the safe procedure----- Nasopharyngeal insufflation technique with entropy monitor will give adequate and safe surgical field 2. Appropriate exposure will help you to delineate the surgical margins 3. Topical anaesthesia before and after the procedure will prevent sudden laryngeal spasm 4. Firm holding of coblation device will help to prevent injury to surrounding structures like anterior 2/3 vocal cord, opposite side vocal cord, medial surface of vocal cord or aryteroid posteriorly 5. Do not ablate more laterally to prevent bleeding, if at all it happens, use patties or coagulation switch for hemostasis. 6. And at the end of the procedure ,use catheter suction to suck out blood clots or saline from the airway if any…. To Conclude-Coblation Assisted Cordectomy( CAC) can be performed safely with good outcomes in case of bilateral vocal cord paralysis using tubeless anesthesia technique without tracheostomy ! Thank you for Watching

Transotic Approach for Cochlear Schwannoma

This video shows a transotic approach for a cochlear schwannoma in a 59-year-old female who presented with sudden sensorineural hearing loss in her left three years prior. She was found to have subsequent growth of her tumor on imaging and elected to undergo surgery. The transotic approach is a valuable approach within the armamentarium of a skull base team and differs from the transcochlear approach in the handling of the facial nerve. Techniques for ear canal overclosure, eustachian tube packing and mastoid obliteration are also highlighted.

Microtia Reconstruction- Auricular Framework Creation from Rib Cartilage

This video demonstrates the carving and creation of the auricular framework as performed by Dr. Rousso after harvesting cartilaginous ribs 6-9. This is a modification of the techniques described by Dr. Nagata and Dr. Firmin. 

Lower Lip Sling Suspension with Bidirectional Fascia Grafts For Isolated Marginal Mandibular Nerve Palsy

The procedure in this video demonstrates a lower lip sling suspension technique for isolated marginal mandibular nerve palsy using bidirectional fascia grafts.

Nasal Dermoid Cyst Excision

This is a case of an 8 month old with a midline nasal mass present since birth. Preoperative physical exam and imaging was consistent with a nasal dermoid cyst with no evidence of intracranial extension.

Novel use of a balloon for bronchial bead foreign body removal

Contributors: Josephine Czechowicz and Sanjay Parikh Removal of a bronchial foreign body with a smooth surface can be challenging with standard optical forceps. The fogarty arterial embolectomy catheter is a suitable alternative, particularly in the setting of a bead or other hollow object. DOI: http://dx.doi.org/10.17797/7gq2gil0v3 Editor Recruited by: Sanjay Parikh

Lateral Temporal Bone Resection

Contributors: Paul W. Gidley, MD This video demonstrates the basic steps of lateral temporal bone resection for cancers involving the ear canal. The lateral temporal bone resection removes the ear canal en bloc, preserving the facial nerve and stapes. DOI: http://dx.doi.org/10.17797/mn4edyy57u Editor Recruited By: Ravi N. Samy, MD, FACS

Revision mastoidectomy

Emphasis on soft tissue removal DOI: http://dx.doi.org/10.17797/1hfipu5fg1 Author Recruited by: Ravi N. Samy, MD, FACS

Use of CO2 laser in preparation for cochlear implant via round window

Use of CO2 laser in preparation for cochlear implant via round window

Sequential Balloon Dilation and Triamcinolone Injection in Premature Infant to Treat Glottic and Subglottic Injury

Contributors: Sanjay Parikh Sequential Balloon Dilation and Triamcinolone Injection in Premature Infant to Treat Glottic and Subglottic Injury. This video with narration shows a marked improvement in neonatal airway edema and successful extubation after three interventions of triamcinolone injection and balloon dilation. DOI# http://dx.doi.org/10.17797/w2iwnogofq Author Recruited by: Sanjay Parikh, MD. FACS

Endoscopic Endonasal Resection of an Esthesioneuroblastoma with Dural Resection and Reconstruction

Contributors: Ehab Hanna and Peleg Horowitz Anterior skull base sinonasal malignancy previously biopsied as esthesioneurobastoma. Tumor extension through the left cribiriform plate and left lamina papyracea. Author Recruited By: Dr. Ehab Hanna

ENDOSCOPIC CARTILAGE MYRINGOPLASTY

This video demonstrates the use of the endoscope in cartilage myringoplasty. DOI# http://dx.doi.org/10.17797/gz02921q1s

Endoscopic Resection of Esthesioneuroblastoma with Dural Resection and Reconstruction

Contributors: Shaan Raza, Ehab Hanna, Peleg Horowitz Anterior skull base sinonasal malignancy previously biopsied as esthesioneurobastoma. Tumor extension through the left cribiriform plate and left lamina papyracea. Author Recruited By: Dr. Ehab Hanna

Flex Robotic-Assisted Branchial Cleft Excision via Retroauricular Approach

Contributors: Umamaheswar Duvvuri An 18-year-old African American female with a large, type II branchial cleft cyst and a history of keloid scars presented for removal of branchial cleft cyst. We present the first robotic-assisted excision of branchial cleft cyst using the new Flex Robotic© Surgery System.

Flexible Laryngoscopy - An Overview

Authors Adam Karkoutli1 Wayne Wortmann1 Rohan R. Walvekar, MD2 Nathan C. Grohmann, MD2 Author Affiliations LSUHSC School of Medicine1 LSUHSC Department of Otolaryngology – Head and Neck Surgery2 Video Description This video demonstrates the procedure for use of firberoptic flexible laryngoscopy. The preoperative steps and recommendations for use of flexible laryngoscopy are outlined. Followed by a visual demonstration of insertion of the laryngoscope along with outlining pertinent landmarks encountered during this procedure.

Laryngeal Papillomatosis with Microlaryngoscopy and Bronchoscopy with Microdebridement, CO2 Laser Ablation, and Cidofovir Injections.

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.

Direct Laryngoscopy and Bronchoscopy: Purpose & Setup

This video is an introduction to operative direct laryngoscopy and bronchoscopy (DLB) and will demonstrate 1) How to set up the equipment for a safe and comprehensive DLB and 2) How to assemble a rigid bronchoscope. Authors: Alexander Moushey1; Taher Valika, MD2; Erik H. Waldman, MD3; Sarah E. Maurrasse, MD3 Voiceover: Vidal Maurrasse 1Yale School of Medicine, New Haven, CT 2Department of Surgery, Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine 3Department of Surgery, Section of Pediatric Otolaryngology, Yale School of Medicine, Yale New Haven Children’s Hospital

Direct Laryngoscopy and Bronchoscopy: Performing a Diagnostic Exam

This video is an introduction to operative direct laryngoscopy and bronchoscopy (DLB) and demonstrates how to perform a safe and comprehensive exam in the operating room. Authors: Alexander Moushey1; Taher Valika, MD2; Erik H. Waldman, MD3; Sarah E. Maurrasse, MD3 Voiceover: Vidal Maurrasse 1Yale School of Medicine, New Haven, CT 2Department of Surgery, Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine 3Department of Surgery, Section of Pediatric Otolaryngology, Yale School of Medicine, Yale New Haven Children’s Hospital

Bryan Medical - Aeris Airway Dilation

Aeris Balloon Demo

Bryan Medical - Tenax Laser Resistant Endotracheal Tube

Tenax Endotracheal Tube Demo

Bryan Medical - Aeris Ballon & Tenax Laser

Demo for Aeris Balloon Dilation System and Tenax Laser Resistant Endotracheal Tube.

Branchial Cleft Cyst Excision

Branchial cleft cysts are a benign anomaly caused by incomplete obliteration of a primordial branchial cleft.  They typically appear in childhood or adolescence, but can appear at any age. They present as a non-tender, fluctuant mass following an upper respiratory infection, most commonly at the anterior border of the sternocleidomastoid muscle. These lesions are thought to originate during the 4th week of gestation when the branchial arches fail to fuse. The second branchial cleft is the most common site (95%) and cysts from in this distribution can affect cranial nerves VII, IX, and XII. 

Repair of Tessier 7 Cleft Lip Deformity

The most common of the rare craniofacial clefts, Tessier's No. 7 cleft is represented by a deficiency of tissue that may span from the oral commissure to the ear. (1) The repair of the cleft of the lip must include especial attention to restoring continuity of the orbicularis oris muscle as well the vermillion. This case is presented as an example of the repair of the Tessier 7 cleft lip deformity. DOI #: http://dx.doi.org/10.17797/4h2edlts5zz

Anterior cervical tracheoplasty using thyroid ala cartilage graft

Acquired tracheomalacia in the form of suprastomal collapse may occur as a complication of long-term tracheotomy dependence. Prolapse of the weakened suprastomal segment of trachea during inspiration may prevent safe decannulation. Management of such an issue may require a secondary surgical procedure such as anterior tracheoplasty.2 In 2001, Forte et al described the use of thyroid ala cartilage as a reliable cartilage source for anterior augmentation laryngotracheal reconstruction in neonates. This technique may yield a favorable result given similar thickness of the cartilages and use of a single incision operation for airway reconstruction.1 Here, we present a modification of the procedure described by Forte for anterior cervical tracheoplasty for the indication of suprastomal collapse preventing decannulation. The procedure begins with nasotracheal intubation and excision of tracheostomy tract and stoma. Strap muscles are then divided to expose the laryngotracheal cartilages. Cartilages are divided at the midline anteriorly, and the diseased segment of anterior trachea is discarded. The defect is measured, and if the size match is favorable, the superior thyroid alar cartilage is harvested. The resulting cartilage graft is slightly larger than the tracheal defect and is placed so that the perichondrium is facing into the airway lumen. Interrupted sutures of 4-0 vicryl are used to inset the graft in a submucosal fashion. Once the graft is secured with sutures, a Valsalva maneuver is performed after the cuff of the endotracheal tube is taken down to assure no leak. Strap muscles are reapproximated, a Penrose drain is placed, and the skin is closed. The child is kept intubated and sedated for 3 days before subsequent extubation in the intensive care unit. A bronchoscopy is performed at the 6-week postoperative interval to assure successful healing and to remove any persistent granulation tissue if present.

Endoscopic Nd:Yag and Bleomycin Injection for the management of a Hypopharyngeal Venous Malformation

Venous malformations (VM) are congenital lesions, frequently affecting the head and neck, with poor respect for tissue planes. Established treatments include observation, sclerotherapy, laser, and surgical resection.1 Lesions affecting the upper airways present unique challenge due to frequent unresectability and difficult access/exposure for alternative standard treatments. We describe our approach of standard endoscopic airway techniques for the administration of advanced treatment modalities including simultaneous laser and sclerotherapy for an extensive airway VM. Our patient is a 16-year-old female with an extensive multi-spatial VM with associated airway obstruction. The patient suffered from severe obstructive sleep apnea (OSA) and continuous positive airway pressure (CPAP) dependence as a result of airway compression. Direct laryngoscopy and bronchoscopy demonstrated extensive venous staining and large vascular channels of the hypopharynx. Lumenis Nd:Yag laser (Yokneam, Israel) via 550 micron fiber was passed under telescopic visualization. Treatment via previously described “polka dot” technique was performed (15W, 0.5 pulse duration) with immediate tissue response. The largest vascular channel was accessed via 25-gauge butterfly needle. Immediate return of blood following lesion puncture confirmed intralesional placement. Reconstituted bleomycin (1 U/kg; max dose = 15 U per treatment) was injected and hemostasis achieved with afrin pledgets. The patient was intubated overnight. She was extubated the next morning and advanced to a regular diet, discharging post-operative day two. Post-operative flexible laryngoscopy demonstrated significant improvement in the treatment areas, and follow up sleep study demonstrated sleep apnea resolution with liberation of her CPAP therapy.

Selective Stapedial tendon and Tensor Tympani tenotomy for the treatment of Middle Ear Myoclonus in a pediatric patient

Objective tinnitus is a rare phenomenon whereby a patient perceives sound in the absence of external auditory stimuli, that is also observed by the examiner. Unlike subjective tinnitus which is thought to be somatosensory and usually difficult to cure, objective tinnitus is more likely to have an identifiable cause amenable to treatment. The differential for objective tinnitus includes aberrant vascular anatomy affecting the temporal bone, patulous eustachian tube function, and abnormal myoclonic activity of the palatal or middle ear muscles.1 We present a 16-year-old female who presented for evaluation of objective tinnitus. On physical examination, an intermittent rhythmic clicking was identified. Visualization of both the tympanic membrane and palate during active audible tinnitus was observed and found to be normal. A hearing test was performed demonstrating normal hearing and speech thresholds as well as normal tympanogram. Acoustic reflex testing demonstrated absent decay in both ears and spontaneous discharge for the right ear in response to both high and very low stimulus indicating abnormal stapedial and tensor tympani function. MRA demonstrated normal vascular anatomy and MRI was obtained demonstrating normal anatomy without lesions of the brainstem, cochleovestibular nerves, or ear or mastoid pathology. The patients was subsequently diagnosed with isolated middle ear myocolonus (MEM). Treatment options including medical versus surgical therapy were discussed as has previously been described. The patient ultimately elected for surgical tenotomy of the stapedial and tensor tympani tendons. Using endoscopic technique, a middle ear exploration was performed. Canal injection was performed with standard tympanomeatal flap elevation was assisted with epinephrine pledgets. The Annular ligament was identified and the middle ear was entered. Additional dissections was performed superiorly, and the chorda tympani nerve was identified and preserved. The stapedial tendon was visualized emanating from the pyramidal eminence to the posterior crus of the stapes. Balluci scissors were used to sharply incise the tendon and the remaining ends were reflected using a Rosen needle to prevent re-anastamosis. Additional dissection along the malleus was performed to gain access to the tensor tympani tendon. A 30 degree angled endoscope was utilized to visualize the tensor tympani tendon extending forward from the cochleariform process to the neck of the malleus. The angled 6400 Beaver blade was used to sharply incise the tendon, requiring multiple passess due to the thickness of the tendon. The sharply incised ends of both tendons were clearly visualized. The tympanomeatal flap was re draped and secured with gel foam packing. The patient was seen in follow up three weeks post operatively with a well healed ear drum, resolution of her objective tinnitus, normal hearing, and absent stapedial reflexes. The patient and mother were happy. Endoscopic stapedial and tensor tympani tenotomy is a feasible technique for isolated MEM in the pediatric population.

Midline Cervical Cleft Excision of Fibrous Cord - Z Plasty Closure

Z-plasty allows broken-line closure, reorientation of the defect in the horizontal plane with re-creation of a cervicomental angle, and most importantly, a lengthening of the anterior neck skin that aids in preventing recurrent contracture. We present our experience managing a congenital cervical midline cleft in a 3-month-old patient and describe a simple technique for planning the ideal Z-plasty closure. No simple description for planning the ideal closure for this defect could be found in the otolaryngology literature.

Adam Zanation, MD

University of North Carolina at Chapel Hill

• Director, Head and Neck Robotic Surgery Program
• Director of the Advanced Head and Neck Oncology, Skull Base, and Rhinology Fellowships
• Associate Professor, Department of Otolaryngology – Head and Neck Surgery

Dr. Adam Mikial Zanation is a tenure tract Associate Professor within the Department of Otolaryngology – Head and Neck Surgery at the University of North Carolina at Chapel Hill. He is also the Director of the Head and Neck Robotic Surgery Program and the Director of the Advanced Head and Neck Oncology, Skull Base, and Rhinology Fellowships. He was born on July 11, 1976, in Concord, North Carolina and attended the University of North Carolina where he was a three-year graduate with honors and research commendation in 1997. He then matriculated to the University of North Carolina School of Medicine where he graduated 1of 4 students in his class with highest honors. Following residency, Dr. Zanation completed a Cranial Base Surgical Oncology Fellowship at the University of Pittsburgh Medical Center. Dr. Zanation’s clinical practices focus on cranial base surgery, specifically employing endoscopic and minimally invasive approaches to complex tumor locations. His clinical research focuses on quality of life, neurofunctional, and neurocognitive outcomes, as well as application of new surgical technology such as robotic surgery to reduce patient morbidity. Dr. Zanation’s translational basic research interests focuses on genomic analyses of head and neck tumors and thyroid cancers for diagnostic and prognostic purposes. Dr. Zanation currently has 70 PubMed Indexed publications and in the last five years has presented at over 60 national and international meetings. Dr. Zanation is married to Jennifer Stegall Zanation who is a Neonatal ICU Pharmacist at UNC Hospitals. They have two young children and enjoy a multitude of outdoor activities.

Ravi N. Samy, MD, FACS

University of Cincinnati

• Director, Cochlear Implant and Auditory Brainstem Implant Program
• Program Director, Neurotology Fellowship
• Associate Professor, Department of Otolaryngology

Dr. Ravi Samy was born in Madras (now Chennai), India. He emigrated to the United States in 1973, at the age of 4. The first city in the US in which he lived was Canton, OH. After spending a few years in Connecticut during his father’s psychiatry residency, he moved to Wichita Falls, TX. He spent most of his formative years in Texas and considers himself a Texan. After graduating high school as co-valedictorian, Dr. Samy matriculated at Duke University. He graduated magna cum laude with a BS in Zoology in 1991. He then stayed on at Duke University School of Medicine and graduated in 1995. From 1995-2000, Dr. Samy was an intern and then a resident at Stanford University School of Medicine, where he developed a love for otology, neurotology, and skull base surgery. From 2000-2002, he was a fellow in Neurotology at the University of Iowa. After graduating, he was an Assistant Professor from 2002-2005 at UT-Southwestern Medical Center in Dallas, TX. Although he never wanted to leave Texas again, he was enamored with a phenomenal academic opportunity in the Department of Otolaryngology at the University of Cincinnati/Cincinnati Children’s Medical Center. He has been there for almost 8 years. He became an Associate Professor last year. During his time here, he has created an ACGME accredited, two-year Neurotology fellowship, one of only approximately 15 in the country. Dr. Samy serves not only as Program Director for the Neurotology Fellowship but also as the Director of the Cochlear Implant and Auditory Brainstem Implant program. His research interests include cochlear and auditory brainstem implantation as well as acoustic neuromas, neurofibromatosis type 2, facial nerve tumors, and other diseases and disorders of the lateral skull base. Finally, he is interested in using novel techniques and technologies to eradicate tumors, such as the use of surgical robotic systems or synthetic biology in the form of bacterial robotics systems. He is collaborating with researchers in India, including one of his former fellows, to incorporate these technologies and to enhance global health and increase collaboration between UC and international institutions, thus benefiting both US citizens and those of other nations.

Dr. Samy’s website, CiSurgeon.org provides information about Cochlear Implants, including FAQ, Cochlear Implant Surgery, preparation and more.

Michael M. Johns, III, MD

Emory University School of Medicine

• Director, Emory Voice Center
• Associate Professor
• Department of Otolaryngology

Dr. Johns is a graduate of Johns Hopkins School of Medicine. He completed his residency in Otolaryngology at the University of Michigan and trained as a research fellow through a National Institute of Health program. He then pursued a fellowship in laryngology and care of the professional voice at the Vanderbilt Voice Center at Vanderbilt University. Dr. Johns was awarded the highest honors during his academic career, including membership in Phi Beta Kappa and Alpha Omega Alpha medical honor society. He is the director of the Emory Voice Center at Emory University, pursing research, teaching and clinical care, with a specific interest in geriatric laryngology and the aging voice.

Ehab Hanna, MD, FACS

The University of Texas MD Anderson Cancer Center

• 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”.

Rohan R. Walvekar, MD

University of Pittsburgh / VA Medical Center

• Assistant Professor in Head Neck Surgery

Rohan R. Walvekar, MD, earned his doctoral degree from the University of Mumbai. After graduating in 1998, he completed a residency in Otolaryngology and Head Neck Surgery at the TN Medical College & BYL Nair Charitable Hospital, Mumbai, India, with triple honors. Subsequently, he completed two head neck surgery fellowships, and trained at at the Tata Memorial Hospital, Mumbai, which is India's most prestigious cancer institute. After completing an Advanced Head Neck Oncologic Surgery fellowship at the University of Pittsburgh, he became an Assistant Professor in Head Neck Surgery within the Department of Otolaryngology Head Neck Surgery at the University of Pittsburgh/VA Medical Center, prior to joining the LSU Health Sciences Center in July 2008. His clinical interests are head neck surgery and salivary endoscopy. His research interests include evaluating prognostic markers and clinical outcomes of head and neck cancer therapy and treatment of salivary gland disorders.

Harold C. Pillsbury, III, MD, FACS

University of North Carolina at Chapel Hill

• Chair, University of North Carolina Department of Otolaryngology
• Thomas J. Dark Distinguished Professor of Otolaryngology/Head and Neck Surgery

Harold C. Pillsbury, III, M.D., F.A.C.S., is the Chair of the UNC Department of Otolaryngology/Head and Neck Surgery, as well as the Thomas J. Dark Distinguished Professor of Otolaryngology/Head and Neck Surgery.

A native of Baltimore, Maryland, Dr. Pillsbury earned his B.A. and M.D. degrees from George Washington University in Washington, DC (1970 and 1972, respectively). He completed his residency training in Otolaryngology/Head and Neck Surgery at the University of North Carolina School of Medicine in 1976. Following six years at the Yale University School of Medicine, he joined the UNC faculty in 1982 as an Associate Professor. He served as Chief of the Division of Otolaryngology/Head and Neck Surgery from 1983 to 2001.

Dr. Pillsbury has completed an eighteen year term on the American Board of Otolaryngology where he served as Exam Chair and President. He is also past President of the American Academy of Otolaryngology-Head and Neck Surgery, The American Laryngological Association, The Society of University Otolaryngologists, and the Triological Society. He is also past CME coordinator and Vice-President of the Southern Section Triological Society. He is the past President of the American Academy of Otolaryngic Allergy.

Dr. Pillsbury has written and/or contributed to over 270 publications and over 45 textbooks. He has also given over 326 presentations nationally and internationally. He has been the primary investigator or co-investigator on over 21 grants. His special field of interest is neurotology and, most especially, cochlear implantation.

Neil Tanna, MD, MBA, FACS

Hofstra Northwell School of Medicine

• Associate Program Director of Plastic Surgery
• Northwell Health
• Associate Professor of Plastic Surgery
• Hofstra Northwell School of Medicine

Dr. Neil Tanna is a Double Board Certified Plastic Surgeon with clinical interest in cosmetic and reconstructive surgery. He is among a very small group of Plastic Surgeons in the world to have completed formal training in Otolaryngology, Plastic & Reconstructive Surgery, and Microvascular Surgery.

After receiving his medical degree from Albany Medical College, Dr. Tanna completed a full Otolaryngology – Head & Neck Surgery residency at The George Washington University. He pursued further training and completed a second full residency in Plastic & Reconstructive Surgery at the University of California, Los Angeles (UCLA). He then completed a fellowship in advanced reconstructive and microvascular surgery at the Institute of Reconstructive Plastic Surgery at New York University (NYU).

Beyond his plastic surgery clinical practice, Dr. Neil Tanna is a mentor, respected educator, and prolific author. Currently, he serves in many leadership roles. He is Chief of Plastic Surgery at one of the one of the Northwell Health hospitals. He is an Associate Professor with the Hofstra University School of Medicine, where he is engaged in the education of students. He also serves as Associate Program Director for the Plastic Surgery Residency with Northwell Health System. He trains resident physicians in becoming Plastic Surgeons.

The medical work and clinical research of Dr. Neil Tanna have been widely published in national and international medical journals. He has authored over 75 publications in major peer-reviewed medical journals and written over 10 textbook chapters. Given his interest in aesthetic and reconstructive surgery of the head and neck, breast, and body, Dr. Tanna has been invited to present at over 75 national and international meetings. He presents the latest advances in plastic surgery to his colleagues and other surgeons from all around the world.

Dr. Neil Tanna has been recognized in the 2015 and 2016 New York Times Super Doctors List for his noteworthy and outstanding achievements.

Umamaheswar Duvvuri, MD, PhD

University of Pittsburgh Medical Center

• Director of Robotic Surgery, Division of Head and Neck Surgery
• Director of the Center for Advanced Robotics Training (CART)
• University of Pittsburgh School of Medicine

Umamaheswar Duvvuri, MD, PhD, is a graduate of the University of Pennsylvania obtaining his Medical Degree in 2000 and his PhD in Biophysics in 2002. He completed an internship in General Surgery in 2003 and residency training in Otolaryngology in 2007 at the University of Pittsburgh Medical Center. He completed fellowship training in Head and Neck Surgery in 2008 at the University of Texas MD Anderson Cancer Center.

He joined the University of Pittsburgh in August 2008 as an Assistant Professor in the Department of Otolaryngology, Head and Neck Surgery Division and is also a staff physician in the VA Pittsburgh Healthcare System.

He serves as the Director of Robotic Surgery, Division of Head and Neck Surgery, at the University Of Pittsburgh School Of Medicine and is the current Director of the Center for Advanced Robotics Training (CART) at the University of Pittsburgh Medical Center. He directs the Cart Training Courses which provide technical and circumstantial resources to initiate and optimize robotic surgery programs.

He has authored numerous research publications and book chapters and is an invited guest lecturer/speaker on the subject of robotic surgery both nationally and internationally.

A Fulbright scholar, his research interests include minimally invasive endoscopic and robotic surgery of the head and neck, tumors of the thyroid and parathyroid glands and molecular oncology of head and neck cancer.

He directs a federally funded laboratory that studies the biology of head and neck cancer. He holds funding from the National Institute of Health, Department of Veterans Affairs and the “V” foundation.

Arlen Meyers, M.D., MBA

• Professor of Otolaryngology, Dentistry, & Engineering (Emeritus), University of Colorado
• Biomedical Entrepreneurship (Faculty), University of Colorado Denver Graduate School
• President & CEO, SoPE
• Chief Medical Officer, Bridge Health
• Chief Medical Officer, Cliexa
• Chairman of the Board, GlobalMindED

Dr. Meyers is a retired professor of otolaryngology, dentistry, and engineering at the University of Colorado Anschutz Medical campus and President and CEO of SoPE. He has founded several medical device companies and is also the cofounder of a medical tourism company. His primary research centers around biomedical and health innovation and entrepreneurship and life science technology commercialization.

A devoted and prolific member of the SoPE community, Dr. Meyers also leads the Colorado Chapter of SoPE.

Dr. Meyers is a consultant for and speaks to companies, governments, colleges and universities around the world who need his expertise and contacts in the areas of bioentrepreneurship, bioscience, healthcare, healthcare IT, medical tourism — nationally and internationally, new product development, product design, and financing new ventures.

He is a former Harvard-Macy fellow and in 2010, he completed a Fulbright at Kings Business, the commercialization office of technology transfer at Kings College in London. Some of his publications include “Building the Case for Biotechnology.” “Optical Detection of Cancer”, and ” The Life Science Innovation Roadmap”. In addition, he is a faculty member at the University of Colorado Denver Graduate School where he teaches Biomedical Entrepreneurship and is an iCorps participant, trainer and industry mentor.

Dr. Meyers serves as the Chief Medical Officer at Bridge Health and Cliexa, as well as Chairman of the Board at GlobalMindED, a non-profit at risk student success network.  He is also an associate editor of the Journal of Commercial Biotechnology and Technology Transfer and Entrepreneurship and Editor-in-Chief of Medscape Reference: Otolaryngology-Head and Neck Surgery.

Dr. Meyers is honored to be named by Modern Healthcare as one of the 50 Most Influential Physician Executives of 2011 and nominated in 2012, and Best Doctors 2013.

Eric Gantwerker MD MS MMSc (MedEd)

• Pediatric Otolaryngologist at Cohen Children’s Hospital at Northwell Health/Hofstra

Eric Gantwerker, MD, MS, MMSc(MedEd), FACS is a Pediatric Otolaryngologist at Cohen Children’s Hospital at Northwell Health/Hofstra, Associate Professor of Otolaryngology at Zucker School of Medicine at Hofstra/Northwell, and Vice President, MedicalDirector at Level Ex. He holds a Master of Medical Science (MMSc) in Medical Education with a special focus on educational technology, educational research, cognitive science of learning,and curriculum development from Harvard Medical School and a Master of Science in Physiology and Biophysics from Georgetown University. Previous Clinical Instructor at Harvard Medical School, Assistant Professor at UT Southwestern, and Associate Professor ofOtolaryngology and Medical Education at Loyola University Chicago Stritch School of Medicine. Dr. Gantwerker’s clinical focus includes complex aerodigestive disorders, airway reconstruction, children with tracheostomies, persistent obstructive sleep apnea, and quality improvement. His academic interests include professional development, educational technology and gaming, motivational theory, and the cognitive psychology of learning. He speaks nationally and internationally through invited lectureships and workshops on implementation of educational technologies and gaming, motivational theory, the cognitive psychology of learning, and putting theory into practice for health professions’ education.

Deanne King, M.D., Ph.D.

• Assistant Professor, University of Arkansas for Medical Sciences
• Director of Clinical Research, Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences

King has a Bachelor of Science in biochemistry from the Texas A&M University in College Station. She has an M.D./Ph.D. in molecular and cellular biology and pathobiology from the Medical University of South Carolina in Charleston. She completed an internship in general surgery and a surgery residency in otolaryngology-head and neck surgery, both at UAMS.

King said she enjoys helping researchers make connections.

“Research can sometimes be an isolating pursuit, but collaboration and idea-sharing is so important to the overall process,” King said. “I’m also looking forward to helping our students and residents. Otolaryngology-head and neck surgery is a highly competitive field. Having published research to your name early in your career is not only a valuable experience, but, increasingly, a necessity for medical students to successfully match into an otolaryngology residency.”

Faculty in the Department of Otolaryngology-Head and Neck Surgery are fellowship-trained in their specialty and cover all the sub-specialties in the field (otology, endocrine, head and neck, rhinology, laryngology, pediatric and vascular anomalies). The faculty consistently receive high scores on patient satisfaction, and six faculty are listed in “Best Doctors in America.” They practice at UAMS Medical Center, Arkansas Children’s Hospital and the Central Arkansas Veterans Health Care System.

Deepak Mehta

• 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.

Gerald B. Healy, M.D., FACS, FRCSI, FRCS

• Professor of Otolaryngology – Head and Neck Surgery, Harvard Medical School
• Past President, American College of Surgeons
• The Healy Chair in Otolaryngology (Emeritus)
• Otolaryngologist-in-Chief (Emeritus), Children’s Hospital, Boston
• Surgeon-in-chief (Emeritus), Children’s Hospital, Boston

Gerald B. Healy, M.D., was born in Boston, Massachusetts and received his undergraduate degree with honors from Boston College in 1963 and his M.D. degree from Boston University in 1967. He is the emeritus Surgeon-in-Chief and the emeritus Gerald B. Healy Chair in Otolaryngology at Children’s Hospital Boston. Dr. Healy is Professor of Otology and Laryngology at Harvard Medical School.

Dr. Healy is a member of numerous honorary societies, including the American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, the Triological Society, the American Laryngological Association, the American Society of Pediatric Otolaryngology and the American Society of Head and Neck Surgery. He has served as President of the Massachusetts Chapter of the American College of Surgeons, the American Society of Pediatric Otolaryngology, the American Bronchoesopagological Association, and the Triological Society (the leading academic society in the specialty of Otolaryngology-Head and Neck Surgery). He has served as Secretary and President of the American Laryngological Association. He is an Honorary Fellow of the Royal College of Surgeons of Ireland and the Royal College of Surgeons of England. He has served as a Chairman of the Board of Regents of the American College of Surgeons and is a past-President of the College. He was the first Otolaryngologist to be elected President. Presently Dr. Healy is a Senior Fellow at the Institute for Healthcare Improvement, Cambridge, Massachusetts.

In 1986, Dr. Healy was elected to the Board of Directors of the American Board of Otolaryngology and served as its Executive Vice-President until 2004. He has also served as a Director of the American Board of Emergency Medicine. He served as a member of the Board of Registration in Medicine in Massachusetts through 2014.

Dr. Healy served as a former Trustee of the Boston Children’s Hospital and Boystown in Omaha, Nebraska.

An active scholar and lecturer, Dr. Healy is the author of several books and book chapters and/or monographs, and is extensively published in peer-reviewed journals. He has been the principal investigator of NIH funded research addressing diseases affecting infants and children and has been cited for his pioneering work with laser surgery in children. In addition he has lectured in North America, Asia and Europe on health care reform, patient safety, the need to restructure medical education and international medical collaboration.

Pediatric Cricotracheal Resection: A Step by Step Surgical Presentation

This talk will focus on the surgical principals of resective airway surgeries with a step by step discussion on the surgical technique of Pediatric Cricotracheal resection.

Sohit Paul Kanotra , MD

Director, Complex Pediatric Airway Program / Associate Professor of Otolaryngology Head and Neck Surgery & Pediatrics
University of Iowa Hospitals & Clinics

Dr. Sohit Kanotra is a Clinical Associate Professor in the Department of Otolaryngology – Head and Neck Surgery and the Department of Pediatrics at the Roy J. and Lucille A. Carver College of Medicine at University of Iowa and the Director of the Complex Pediatric Airway program at University of Iowa Hospitals & Clinics. He has clinical expertise in the management of children with complex airway disorders including open airway reconstructive surgeries. He also has clinical interest in the management of Head and Neck vascular anomalies, pediatric thyroid disorders, minimally invasive endoscopic ear surgery and robotic airway surgery. Dr. Kanotra joined University of Iowa in 2019 prior to which he was the Director of the Pediatric Aerodigestive Center and the surgical director of the vascular anomalies’ clinic at Children’s Hospital of New Orleans in Louisiana.

Overview of Keratosis Obturans

Attendees will learn more about Keratosis Obturans and common complications that arise during the procedure. Panelists will answer audience questions during the presentation.

Sreeshyla Basavaraj MBBS, DLO, FRCS (ORL)

Consultant ENT Surgeon
St. Mary's Hopsital, IOW

Dr. Basavaraj was accredited by the Specialist Advisory Committee in Otorhinolaryngology - Head & Neck Surgery and has been awarded his Certificate of Completion of Specialist Training by the Specialist Training Authority of the Surgical Royal Colleges in 2009. After completion of his higher surgical training in Ear Nose Throat & Head Neck surgery in Liverpool, he worked as a Locum Consultant at Queen Alexandra hospital, Portsmouth. He was trained in all sub-specialities of ENT Head and Neck surgery with a sub-speciality interest in Otology. He, along with his other two colleagues, provides 24/7 ENT service for the Island population.

Advanced Salivary Endoscopy: Challenging Cases Diagnosis & Treatment

The advanced course will assume a basic understanding of the procedure. It will include complex interventions including endoscopic and combined open (transoral and external procedures), complications and management of complications, approach to revision surgery, in-office procedures, advanced radiology, and will include case studies.

Meet the Course Directors!

Rohan R. Walvekar, MD

Assistant Professor in Head Neck Surgery

University of Pittsburgh/VA Medical Center

Rohan R. Walvekar, MD, earned his doctoral degree from the University of Mumbai. After graduating in 1998, he completed a residency in Otolaryngology and Head Neck Surgery at the TN Medical College & BYL Nair Charitable Hospital, Mumbai, India, with triple honors. Subsequently, he completed two head neck surgery fellowships, and trained at at the Tata Memorial Hospital, Mumbai, which is India's most prestigious cancer institute. After completing an Advanced Head Neck Oncologic Surgery fellowship at the University of Pittsburgh, he became an Assistant Professor in Head Neck Surgery within the Department of Otolaryngology Head Neck Surgery at the University of Pittsburgh/VA Medical Center, prior to joining the LSU Health Sciences Center in July 2008. His clinical interests are head neck surgery and salivary endoscopy. His research interests include evaluating prognostic markers and clinical outcomes of head and neck cancer therapy and treatment of salivary gland disorders.

Barry M Schaitkin, MD

Professor of Otolaryngology

UPMC Pittsburgh

Dr. Schaitkin specializes in the treatment of inflammatory and neoplastic conditions of the salivary glands. He practices at UPMC in the Department of Otolaryngology and is affiliated with UPMC branches all across the city of Pittsburgh. He completed his medical degree and residency at Pennsylvania State University College of Medicine.

Meet the Presenters!

Jolie Chang, MD

Associate Professor, Chief of Sleep Surgery and General Otolaryngology

University of California, San Francisco

Dr. Chang specializes in sleep apnea surgery and minimally invasive approaches to the salivary duct with sialendoscopy. She has interest in studying patient reported outcomes after sialendoscopy procedures.

Mark Marzouk, MD

Clinical Associate Professor of Otolaryngology - Head and Neck Surgery

SUNY Upstate Medical University

Dr. Marzouk completed his residency training in 2010 from the UPMC Department of Otolaryngology. He is currently the Division Chief of Head and Neck Oncologic Surgery in Syracuse. He is also the Associate Program Director of Residency Programs.

David W. Eisele, MD. FACS

Andelot Professor and Director - Department of Otolaryngology-Head and Neck Surgery

Johns Hopkins University School of Medicine

Dr. Eisele is the Past-President of the American Board of Otolaryngology- Head and Neck Surgery and a member of the NCCN Head and Neck Cancer Panel. He has served as a member of the Residency Review Committee for Otolaryngology, as Chair of the Advisory Council for Otolaryngology - Head and Neck Surgery for the American College of Surgeons, President of the American Head and Neck Society, and as Vice-President of the Triological Society. He served as President of the Maryland Society of Otolaryngology and is a former Governor of the American College of Surgeons.

M. Boyd Gillespie, MD, MSc, FACS

Professor and Chair

UTHSC Otolaryngology-Head and Neck Surgery

M. Boyd Gillespie is Professor and Chair of Otolaryngology-Head & Neck Surgery at University of Tennessee Health Science Center. He is a graduate of the Johns Hopkins University School of Medicine where he a completed residency and fellowship in Otolaryngology-Head & Neck Surgery. Dr. Gillespie earned a Masters in Clinical Research at the Medical University of South Carolina, and is board certified in Otolaryngology-Head and Neck Surgery and Sleep Medicine. He has published over 150 academic papers and is editor of the textbook Gland-Preserving Salivary Surgery: A Problem-Based Approach. He is a former Director of the American Board of Otolaryngology-Head & Neck Surgery (ABOHNS) and current member of the otolaryngology section of the Accreditation Council for Graduate Medical Education (ACGME).

M. Allison Ogden, MD FACS

Professor & Vice-Chair of Clinical Operations - Department of Otolaryngology

Washington University School of Medicine

Dr. Ogden is a Professor and Vice-Chair of Clinical Operations in the Department of Otolaryngology at Washington University School of Medicine. She graduated from the Washington University School of Medicine in 2002 and went on to complete her residency there as well in Otolaryngology in 2007. Her clinical interests include sialendoscopy, nasal obstructions, and hearling loss. In 2015 Dr. Ogden was listed in "Best Doctors in America", an honor that continues to this day.

Arjun S. Joshi, MD

Professor of Surgery

The George Washington University School of Medicine & Health Sciences

Arjun Joshi, MD is board-certified in Otolaryngology and Head & Neck surgery by both the American Board of Otolaryngology – Head and Neck Surgery and the Royal College of Physicians and Surgeons of Canada. Dr. Joshi received his medical degree from the State University of New York at Syracuse and completed his residency at The George Washington University Medical Center. His areas of expertise include: Head and Neck Cancer, Head and Neck Masses, Head and Neck Reconstruction, Thyroid and Parathyroid Surgery, and Salivary Endoscopy.

Henry T. Hoffman, MD

Professor of Otolaryngology / Professor of Radiation Oncology

University of Iowa Healthcare

Dr. Henry T. Hoffman is an ENT-otolaryngologist in Iowa City, Iowa and is affiliated with University of Iowa Hospitals and Clinics. He received his medical degree from University of California San Diego School of Medicine and has been in practice for more than 20 years.

David M. Cognetti, MD, FACS

Professor and Chair of Department of Otolaryngology-Head & Neck Surgery

Thomas Jefferson University

Dr. Cognetti received his BS in Biology from Georgetown University and his MD from the University of Pittsburgh School of Medicine. He completed a residency in Otolaryngology – Head and Neck Surgery at Thomas Jefferson University before completing a fellowship in Advanced Head and Neck Oncologic Surgery at the University of Pittsburgh Medical Center.  Dr. Cognetti returned to Jefferson, his professional home, as faculty in 2008.

Christopher H. Rassekh, MD, FACS

Professor in Department of Otorhinolaryngology - Head & Neck Surgery / Director of Penn Medicine Sialendoscopy Program

University of Pennsylvania

Christopher H. Rassekh, MD is Professor of Clinical Otorhinolaryngology-Head and Neck Surgery at Penn Medicine. He is the Director of the Penn Medicine Sialendoscopy Program, which provides evaluation of and minimally invasive surgery for diseases that cause swelling of the salivary glands including obstructive diseases such as salivary stones, salivary duct strictures and tumors. Dr. Rassekh sees patients with head and neck tumors including cancers of the mouth, throat, voice box, salivary gland, thyroid and neck and also was a very early adopter of Transoral Robotic Surgery (TORS) for tumors and salivary gland diseases, and is an expert in cranial base surgery. He also is co-chair of the Airway Safety Committee at the Hospital of the University of Pennsylvania.

Cleft Lip Revision: Tips and Tricks

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

Panelists

Alveolar Bone Graft Surgery: Tips and Tricks

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.

Pediatric Endoscopic Airway Surgery

This webinar will address common and advanced pediatric airway pathology. There will be a focus on video demonstration of advanced surgical endoscopic management of pediatric airway pathology ranging from laryngomalacia to type 3 laryngeal clefts.

Vikash K. Modi, MD, is an Associate Professor and the Chief of Pediatric Otolaryngology - Head & Neck Surgery at New York Presbyterian Hospital- Weill Cornell Medical Center. After receiving his medical degree from the Rutgers Medical School, Dr. Modi completed his residency in Otolaryngology at the University of Southern California - Keck School of Medicine. Following residency, Dr. Modi completed a Pediatric Otolaryngology fellowship at Northwestern University - Children's Memorial Hospital. He founded the Cornell Aerodigestive Center and has one of the largest series of endoscopic posterior cricoid split with rib grafting (presented at ESPO). He also has presented his work on endoscopic repair of laryngeal clefts at ASPO and CEORL. He has been inducted as a Fellow, into the prestigious Triological Society for his thesis paper on airway balloon dilation and currently serves as a Section Editor-Video Editor of The Laryngoscope and is known for his surgical endoscopic airway videos.

Transnasal Esophageal Dilation from the OR to the Office

Brought to us by our colleagues at Cook Medical, please join us as we hear from Dr. Gregory Postma, Professor and Vice Chair Department of Otolaryngology-Head and Neck Surgery Medical College of Georgia Augusta University, and Dr. Rebecca Howell, Director of the Swallowing Center, UC Health, as they discuss and share some best practices on the transition of transnasal esophageal dilation, from the OR to the office. Please note that certain Cook Medical products, such as the Hercules® 100 Transnasal Esophageal Balloon discussed in this webinar are only available for use in the United States.

Dr. Robert Ossoff

Join us in the journey of the legend as he gives us insights into his life and his achievements. Join us to be inspired by one of the best physicians in his field.

Most known for being the first Maness Professor and chair of Otolaryngology and for his role in founding the Vanderbilt Voice Center in 1991, Dr. Ossoff has held an array of positions since he joined Vanderbilt’s faculty in July 1986, including the first director for the Vanderbilt Bill Wilkerson Center for Otolaryngology and Communication Sciences, associate vice chancellor for Health Affairs, chief of staff for Vanderbilt University Adult Hospital, assistant vice chancellor of Compliance and Corporate Integrity and executive medical director for the Vanderbilt Voice Center. He was also highly involved with the creation of the Free Electron Laser Center at Vanderbilt University, bringing with him knowledge he gained during his residency and faculty appointment at Northwestern University in Chicago.

Dr. Ossoff will be joined by Dr. Michael Johns, Director, USC Voice Center, Dr, Albert Merati, Chief of Laryngology, UW Medicine’s Head and Neck Surgery Center, and Dr. Gaelyn Garrett, Professor and Vice-Chair, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center.

Augmented Balloon Dilation with Dr. Michael Rutter

In partnership with our colleagues at Bryan Medical (www.bryanmedical.net), this next installation of CSurgeries’ series on laryngology features Dr. Michael Rutter, Director of UC’s Aerodigestive Center and Professor of Pediatrics, as he presents his approach to Augmented Balloon Dilation. Dr. Rutter will share video content of previous cases along with detailed commentary on his approach.

Dr. Michael Rutter is an ENT surgeon specializing in pediatric otolaryngology with an emphasis on airway problems in children, adolescents and young adults. His interests include tracheal reconstruction and complex airway surgery. Dr. Rutter was honored to receive the 2016 Gabriel Frederick Tucker Award from the American Laryngological Association, and the 2018 Sylvan Stool Teaching Award from the Society for Ear Nose and Throat Advancement in Children (SENTAC). These awards are for his contributions to the field of pediatric laryngology.

Battle of the Medialization Techniques: Michael “Type 1 Thyroplasty” Johns vs. Julina “Reinnervation” Ongkasuwan

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?

Current Techniques, Pearls and Strategies for Cochlear Implantation

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.

The Good, The Bad, and The Ugly: Awake Vocal Fold Injections

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.

Salivary Interactive Case Study

Submit your own cases to be reviewed by our Salivary Surgery Experts, Dr. Rohan Walvekar and Dr. Barry Schaitkin. Cases will be selected prior to the session and those selected will be notified. Our experts, joined by guest panelists, will review the case details, provide their perspective, and go over alternative methods to consider when presented with a similar case.

If you feel uncomfortable submitting patient information, you can just bring the information to the session and present it directly to the experts. Here is what you need to have prepared when you join the webinar:
• Short patient history - medical and surgical
• Findings from images or scans - the actual images and scans are helpful too
• Any kind of operative images or videos that can help showcase the problem
• A question to pose to the expert panel

Cleft Primary and Revision Rhinoplasty: Tips and Tricks

Tune in for the latest in our series on Cleft Surgery featuring Dr. Raj Vyas from UC Irvine and Dr. Usama Hamdan with the Global Smile Foundation. The discussion will focus on making sure that attendees know proper procedures as well as common complications and how to avoid 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. Hamdan is President and Co-Founder of Global Smile Foundation, a 501C3 Boston-based non-profit foundation that provides comprehensive and integrated pro bono cleft care for underserved patients throughout the world. He has been involved with outreach cleft programs for over three decades. Dr. Hamdan is an Otolaryngologist/Facial Plastic Surgeon with former university appointments at Harvard Medical School, Tufts University School of Medicine and Boston University School of Medicine. For his philanthropic service to the people of Ecuador, he was awarded the Knighthood, “Al Merito Atahualpa” En El Grado De Caballero, by the President of Ecuador in March 2005. He received Honorary Professorship at Universidad de Especialidades Espíritu Santo, School of Medicine, in Ecuador on March 5, 2015 for his contributions in the field of Cleft Lip and Palate.

Dr. Vyas obtained his BS from Stanford and his MD from UCLA before completing integrated plastic surgery residency at Harvard and a fellowship in Craniofacial Surgery at NYU. He is an active clinician, scientist and educator with over 200 peer-reviewed publications and presentations, 20 book chapters, dozens of invited lectures, and multiple NIH and foundational grants. Dr. Vyas is passionate about advancing knowledge and skill for cleft care worldwide, partnering with Global Smile Foundation as both a clinician and Director of Research.

After completing a pediatric craniofacial fellowship at Boston Children’s Hospital, he joined the Division of Plastic and Reconstructive Surgery at Washington University in St. Louis 2011. He is Director of Craniofacial and Medical Director of the Operating Rooms at Saint Louis Children’s Hospital (SLCH). He treats patients with craniosynostosis or other craniofacial abnormalities (congenital or traumatic). He obtained a Master of Science in Clinical Investigation in May 2017 at Washington University to advance his ability to perform high quality clinical research and this program allows him to take advantage of the tremendous resources available for faculty and residents. His research focus is in craniofacial with particular interest in craniosynostosis and cleft lip and palate.

Dr. David Yates MD, DMD, FACS is passionate about serving children with Cranial and Facial deformities and Cleft Lip and Palate. He is a Board Certified Oral and Maxillofacial Surgeon and was recently awarded the inaugural “Physician of the Year” award by El Paso Children’s Hospital. He is the Division Chief of Cranial and Facial Surgery at El Paso Children’s Hospital and has been critical in bringing complex craniofacial surgery to the region. In addition to being a partner with High Desert Oral and Facial Surgery, he directs the craniofacial clinic at El Paso Children’s Hospital and the craniofacial clinic at Providence Memorial Hospital. He has also been integral in starting a clinic for children with Cleft Lip and Palate in Juarez, Mexico at the Hospital De La Familia (FEMAP). He is now happily settled with his wife and four kids serving the greater El Paso/Las Cruces/Juarez region.

What is Otolaryngology: More than Tonsils and Boogers

Come learn more about the jobs of Otolaryngologists (also known as ENT doctors!). We will discuss the breadth and depth of what ENT doctors cover with case descriptions. Medical students and residents of different levels will be on a panel to answer questions about the journey to and through Otolaryngology residency.

Otolaryngology Head and Neck Surgery / Resident Physician, PGY 5
Loyola University Medical Center

Dr Yang grew up in the arid and desert like climate of Eastern Washington before spending four years in rainy Seattle during her undergrad years, majoring in Neurobiology at the University of Washington. She then moved to sunny Southern California to complete her medical education at Loma Linda University School of Medicine. She is currently finishing her chief year of Otolaryngology Head and Neck Surgery residency at Loyola University Medical Center in Chicago, enjoying both life in the Windy City and surviving the cold winters. She recently matched to fellowship at Oregon Health and Science University in Facial Plastics and Reconstruction with Dr. Wax to specialize in microvascular reconstruction of complex head and neck defects. She is excited to return to the west coast and explore all the nature that Oregon has to offer.

Resident physician
University of Nebraska Medical Center

Steven is originally from San Diego, CA and attended the University of Notre Dame where he studied anthropology. He then earned a master's degree at Boston University and completed a year of service with Jesuit Volunteer Corps Northwest in Yakima, WA. Steven recently graduated from Loyola University Chicago Stritch School of Medicine and will be starting otolaryngology residency at the University of Nebraska Medical Center.

Medical Student
Loyola University Chicago Stritch School of Medicine

Alice is originally from San Jose, CA and attended UC Berkeley where she studied Molecular and Cell Biology as well as Nutrition. She is starting her fourth year at Loyola University Chicago Stritch School of Medicine, and preparing to apply for otolaryngology residency.

Resident
Loyola University Medical Center Otolaryngology Head and Neck Surgery Department

Dr. Sandelski grew up in Northwest Indiana, leaving the state for undergrad at the University of Michigan, and returning for medical school at Indiana University School of Medicine. She is in her second year at Loyola for ENT residency. She is undecided for plans after residency, with current interests in head and neck oncology and facial plastics and reconstruction.

The Middle Fossa Approach: How I Do It

The Middle Cranial Fossa Approach is arguably one of the most challenging procedures in skull-based surgery, and yet is often under-utilized in spite of its many advantages. Watching videos of this approach can help one over time become an outstanding middle-cranial fossa surgeon.

Associate Professor and Director of the Skull Base Surgery Fellowship
University of Cincinnati Medical Center

Dr. Ravi Samy has been an otolaryngologist at the University of Cincinnati Gardner Neuroscience Institute and the director of the Skull Base Surgery Fellowship at the UC College of Medicine since 2005. He is also the director of the Adult Cochlear Implantation Program at the University of Cincinnati Medical Center (UCMC), as well as an associate professor of Otolaryngology at the College.

Salivary Interactive Case Study: July

Submit your own cases to be reviewed by our Salivary Surgery Experts, Dr. Rohan Walvekar and Dr. Barry Schaitkin. Cases will be selected prior to the session and those selected will be notified. Our experts, joined by guest panelists, will review the case details, provide their perspective, and go over alternative methods to consider when presented with a similar case.

If you feel uncomfortable submitting patient information, you can just bring the information to the session and present it directly to the experts. Here is what you need to have prepared when you join the webinar:
• Short patient history - medical and surgical
• Findings from images or scans - the actual images and scans are helpful too
• Any kind of operative images or videos that can help showcase the problem
• A question to pose to the expert panel

Management of VPD in 22q Deletion Syndrome

This seminar will review the pathophysiology, assessment, and surgical management of velopharyngeal dysfunction in children with 22q deletion syndrome.

Richard E. Kirschner, M.D., F.A.C.S, F.A.A.P.

Chief, Department of Plastic and Reconstructive Surgery / Director, Cleft Lip and Palate Center
Nationwide Children’s Hospital in Columbus, OH

Richard E. Kirschner, M.D., F.A.C.S, F.A.A.P. is Robert and Edgar T. Wolfe Foundation Endowed Chair, Chief of the Section of Plastic and Reconstructive Surgery, Director of the Cleft Lip and Palate Center, and Co-Director of the 22q Center at Nationwide Children’s Hospital.  He serves as Professor of Surgery and Senior Vice Chair of the Department of Plastic Surgery at The Ohio State University College of Medicine.  Dr. Kirschner served as President of the American Cleft Palate-Craniofacial Association in 2016.  He is co-editor of Comprehensive Cleft Care, now in its second edition, and of the upcoming publication Cleft Palate and Velopharyngeal Dysfunction.  He is co-founder of Casa Azul America, Inc., a non-profit organization devoted to providing education to professionals and care to underprivileged children with cleft lip and palate in Latin America and of Magical Moments Foundation, a wish granting charitable organization dedicated to serving children with facial differences.

Salivary Interactive Case Study: August

Submit your own cases to be reviewed by our Salivary Surgery Experts, Dr. Rohan Walvekar and Dr. Barry Schaitkin. Cases will be selected prior to the session and those selected will be notified. Our experts, joined by guest panelists, will review the case details, provide their perspective, and go over alternative methods to consider when presented with a similar case.

If you feel uncomfortable submitting patient information, you can just bring the information to the session and present it directly to the experts. Here is what you need to have prepared when you join the webinar:
• Short patient history - medical and surgical
• Findings from images or scans - the actual images and scans are helpful too
• Any kind of operative images or videos that can help showcase the problem
• A question to pose to the expert panel

Voice Feminisation Surgery

This webinar will discuss modern approach to voice feminisation including therapy and surgery.

The Ins and Outs of Medical Research & Publication

The International Journal of Medical Students and CSurgeries have come together to provide and exclusive inside scoop on the world of medical publications. They will review how to properly research and submit an article along with selecting the best journal to publish through.

Csurgeries Was Live! You’ve Matched! What’s Next? With Dr. Juliana Bonilla-velez

On April 11^th, 2018 we were honoured to have Dr. Juliana Bonilla-Velez host a Facebook Live event titled ‘You’ve Matched! What’s Next?’. Dr. Bonilla-Velez is the chief resident for Otolaryngology, Head and Neck Surgery at the University of Arkansas for Medical Sciences. Originally from Colombia, she is also a founder, editorial board member and former Editor in Chief of the International Journal of Medical Students.

Dr. Bonilla-Velez shared her tips on the exciting transition from medical school to residency.  Medical students will find her discussion and step by step instructions interesting and informative as she fills in the gaps in terms of what happens next!

Topics Dr. Bonilla-Velez covers include:

• First off, celebrate, you did it!
• What to do in the months leading up to your residency
• Preparing for paperwork from your new institutions
• Moving to new cities
• Your first day of residency
• Reaching out for support, it’s okay to ask for help
• Educate yourself with survival guide like materials to know what is expected of you
• Managing clinical responsibilities
• Taking care of yourself
• Staying engaged with activities outside the clinic: Volunteering, research, academics, field organisations & associations
• Staying on top of your readings and research to continue progressing in your clinical studies
• Building leadership by getting involved in the medical community, student leadership groups, mentorships
• Setting goals over your residency
• The benefits of working with Journal Publications – IJMS. 

Key Take-Aways:

• Your colleagues have all been through it before, they can support you!
• Take your time, don’t get overwhelmed by your clinical responsibilities and make sure to take care of yourself first
• Keep and build connections in academia, the medical community and in your clinical field
• Seek leadership opportunities within your clinical field
• Set goals you can achieve over your residency.

How Surgical Videos Benefitted This Aspiring Surgeon’ By Andrew J Goates, Md

 Andrew J. Goates, MD is a first-year Otolaryngology — Head and Neck Surgery resident at Mayo Clinic in Rochester, Minnesota. He is passionate about patient and physician education through  the use of video and digital media and a member of the CSurgery Student Leaders. You can follow him on Twitter @goatesworld and on Instagram @goatolaryngologist. 

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“I like making movies, but I’m not sure what I’m going to do with it. Hopefully I’ll figure it out.”

That was my response. Those were my big career goals. It was our first date and I had just blown my opportunity to knock her socks off with my impressive aspirations and intellectual prowess. Somehow, despite her better judgement and advice of close friends, she continued allowing my romantic pursuits. Eventually, with her support, I discovered my love for medicine. We talked about my role models, many of which were in the medical field. I recognized that I wanted to do something everyday that brought new questions, challenges, and opportunities and at the same time directly impacted peoples’ lives. Medicine became the natural fit.

While in medical school and I spent the first two years trying to gain as much knowledge and experience as I could in order to match into my dream specialty of Otolaryngology– Head & Neck Surgery. I worked in the department as often as I could: helping with publications; attending lectures and grand rounds; all the while learning from residents, fellows, and staff surgeons. One of my mentors approached me about doing a surgical video on a new technique he had learned for excision of branchial cleft cysts. I didn’t know how to remove any type of cyst, and I didn’t even know what a branchial cleft cyst was. But, I did have a natural drive and curiosity, the motivation to learn, and a basic video editing skill set that I could contribute.

Through developing that video I saw the potential of surgical video footage in many aspects of education in surgery and medicine. I learned the practical anatomy relevant to this surgery. I learned about common pitfalls and picked up on the subtleties of technique and tissue handling. Although at that point I had not performed a single surgery, I got to spend a few moments in the mind of a surgeon. I became more prepared for when my opportunity to operate would soon come. In addition, I got to spend important moments learning from and working with a phenomenal surgeon. That project helped strengthen our mentoring relationship and lead to more opportunities for me to reach my potential with a strong letter of recommendation for residency applications.

Since that time I have consistently used high-quality surgical videos to research procedures, learn complex anatomy, and to augment my study of head and neck surgery. Surgical videos can help a learner assimilate difficult three-dimensional relationships and translate memorized anatomy and concepts into practical understanding needed to safely navigate a given operation. This allows a growing surgeon have a foundation on which to build the surgical skills needed to become a proficient and safe surgeon. I have really appreciated the work of CSurgeries in housing excellent surgical videos and making them available for all to benefit from.

So my career does involve making movies after all. But they are far more meaningful than what I had in mind. They don’t just tell stories. These movies teach, inspire, and motivate aspiring surgeons and inform nervous patients and their families from all over the world.

CSurgeries: An International Perspective With Dr. Juliana Bonilla-Velez

Dr. Juliana Bonilla-Velez

PGY 4 – Otolaryngology – Head and Neck Surgery, University of Arkansas for Medical Sciences
​

Tell me a little bit about yourself.

My name is Juliana Bonilla-Velez, and I’m a 4th year resident at the University of Arkansas for Medical Sciences. I’m originally from Colombia, and that’s where I did my medical training. I was very fortunate to work with Dr. Rocco at Mass Eye & Ear Institute as a postdoctoral research fellow on oropharyngeal cancer, and then I came to do my residency training at UAMS. Here, I was also very fortunate to be able to work with Dr. Richter – who is not only one of the founders but an avid promoter of CSurgeries.

He introduced me to CSurgeries very early on in my training. It really is an amazing tool, especially for residents to be able to easily visualize all the things that you are reading!  At times, it can be difficult to put all the aspects of a surgery together (especially if you haven’t seen that type of surgery before) or to learn how different people [surgeons] do things. There are so many different techniques for each type of surgery, so I feel like it’s a great avenue that enriches resident education.

Dr. Bonilla-Velez, I understand you published with CSurgeries in June 2016.  What can you tell me about your experience? Was it easy? Difficult?

It was my first experience making a video, so that was a little challenging. I was working together with a medical student and we made a really good team.  She worked a bit more on the media aspect of helping to put the video together, but then we were able to work together and incorporate some of the more technical aspects of the surgery, and important steps and findings to highlight.

In fact, the recording of the procedure was not difficult at all. It did not interfere with the clinical aspect of what we were doing. The surgery went great, and recording did not obstruct it, make it slower or impose any impediment to the completion of the surgery. At the same time, it was very insightful to be able to review all of it and to put it together in a format that would be easy to teach others what was going on. Not only was it a great experience…it was fun!

It’s very interesting that as a resident you were able to partner with a medical student to take over the technical aspect of video recording and editing while you were able to oversee and supervise the surgical content. Having recently partnered with the International Association of Student Surgical Societies, it confirms that we’re going in the right direction. 

Absolutely. Even as a medical student, I was very involved in research and publication. I was actually one of the founders of the International Journal of Medical Students which was an amazing experience, but also gave me a better understanding of the other side of making science. From a medical student’s perspective, it is such an enriching and fulfilling experience to be able to participate in all of these avenues for publishing – participate in research projects, writing manuscripts or making videos – just learning how to think in that way, getting your feet wet and learning all of these skills are so important for the rest of your career as a physician, especially now with evidence-based medicine.

How has publishing with CSurgeries contributed to education as a surgical resident?

As an author, it was very interesting to be able to go through the process of putting the video together, thinking through all the technical aspects of what we were doing and summarizing it in a short format that would be easy to show others.

As a viewer and user of CSurgeries, it allows you to be able to see different techniques for different types of surgeries. Perhaps the Attending at your institution is doing the procedure one way, but seeing how others are doing it in other places certainly enriches your education. In preparation for surgery, CSurgeries publications allow you to see what the steps are, so you can get a more visual understanding of what it is you are going to be doing and what you’re reading in the books. In surgery, even more so than other specialties, this is critical. Learning in 2D in one thing.  Being able to see in 3D what it is you’re actually going to be seeing in surgery is quite another. For that reason, CSurgeries is definitely a very valuable tool – especially for people in training.

As a user of CSurgeries, is there a particular CSurgeries publication you recommend (either within or outside of your specialty) you recommend for our members to view and why?

As a 4th year resident, at least in my program, we haven’t started our otology rotation, so I feel like I struggle a little bit more trying to imagine and put together all the otologic surgeries. I haven’t been exposed to them nor have I seen them before. For that reason, one video that was very useful to me that I really enjoyed was Right Stapedotomy that was published by Dr. Babu at the Michigan Ear Institute. Just seeing the video, especially with the ear (it’s such intricate anatomy) was extremely useful. Having access to such a high-quality video that walks you through the surgery, seeing all the steps clearly, was really great.

Of course, there are going to be personal circumstances for which you would find a video more educational than others- depending on what your institution does or your prior experiences. One of the really neat things about CSurgeries is that there’s so much variety- not only within otolaryngology, but among all the other specialties. It’s got something for everyone.

You mentioned you are also a founder of the International Journal of Medical Students. What can you tell me about the IJMS?

Our vision was to create a space that would be made by medical students for medical students to promote research and to provide an avenue for publication that would include all specialties. We aim to speak to medical students who are in a unique part of their training. Not only do we offer a window for them to show their publications, but we are able to help get them to that high-quality level of having a paper that is amenable for publication.

It was also a very exciting to build a team of people that would be able to represent all  – not only from around the globe but also those in different stages of their training. We have mentors who have guided us from the beginning, taught us to put all these pieces together and to provide not only an avenue but a service for medical students worldwide where they can publish their work and learn. Especially nowadays where medicine is guided by the paradigm of Evidence-Based Medicine, it’s critical for physicians to be able not only to do research but to understand the research that is published. It serves to train both the authors and the students who are learning to be the editors about all the different aspects of the publication process.  It’s been a really very rewarding experience knowing we’ve been able to contribute to medical students’ education worldwide.

How is publishing with CSurgeries different from publishing with IJMS? How are they similar?

It’s different in the sense that the CSurgeries is a video peer-reviewed journal. It’s very visually perfect for the surgical field because it takes you through the novel of each surgery by  showing what the key structures are and the key steps you need to be doing. It’s very educational, especially for people in training. In terms of similarities, both aim to educate physicians, students and other surgeons. IJMS provides an avenue for written publication of research along with the more traditional strategies while CSurgeries provides an avenue for video publication. Both share a common mission of education.

What advice do you have for international medical graduates looking to pursue surgical residency in the United States?

It’s certainly a very difficult task, but at the same time, it can be immensely rewarding. You have to be very passionate about what you want to do, what you want to accomplish, and what you want for your life. If your goals are clear and you can translate all that passion into hard work and dedication to your specialty, that goes a long way. It’s certainly hard but not impossible. I’d highly encourage you to push through the difficulties if you feel that’s your life mission. Don’t give up on your dreams.

What would you be doing if you were not a surgeon?

Oh gosh! There is nothing else I would rather be doing! I wish I could have a parallel life to be able to do all the things I want to do, but all at the same time. But certainly the life I would not give up is being a future pediatric otolaryngologist and be able to continue to participate in academics, in research and education, and in clinical practice and leadership.  I look forward to playing a part in furthering the field

Watch Dr. Juliana Bonilla-Velez’s video Excision of Thyroglossal Duct Cyst and her Facebook Live, You’ve Matched, What’s Next?

Meet our Course Directors!

The International Airway Symposium is coming up on February 4th & 5th. For more information view the itinerary or register here!

Dr. Guri Sandhu

Chief of Service and Professor of Laryngology

Imperial College London

Prof Sandhu founded the National Centre for Airway Reconstruction in the UK. This is one of the largest adult airway services in Europe. He has extensively researched the numerous causes and treatments for laryngotracheal stenosis and manages these patients with a multidisciplinary approach. He has co-produced three textbooks of Laryngology with one on the subject of laryngotracheal stenosis. He is currently the President of the British Laryngological Association.

Dr. Julina Ongkasuwan

Director of the Pediatric Voice Clinic

Texas Children’s Hospital

Dr. Ongkasuwan is the Director of the Pediatric Voice Clinic at Texas Children’s Hospital. She is dual fellowship trained in both Pediatric Otolaryngology and Laryngology. When she joined the faculty in 2011, she founded the Texas Children’s Hospital Aerodigestive Program and the Swallow Disorders Clinic. Dr. Ongkasuwan’s clinical and research focus is voice, airway, and swallowing disorders in both adults and children with particular interest in the management of vocal fold movement impairment.

Dr. Chadwan Al Yaghchi

Consultant Laryngologist & ENT Surgeon

Imperial College Healthcare NHS Trust

Mr Chadwan Al Yaghchi is a consultant laryngologist at the National Centre for Airway Reconstruction with a specialist interest in airway stenosis, transgender voice and dysphagia. In addition to his adult service, he is an honorary consultant at The Royal Brompton and Harefield NHS Foundation Trust where he manages children with complex airway, respiratory and swallowing conditions. He holds a PhD in Molecular Oncology from Queen Mary’s University of London.

Meet our Presenters for Day 1!

The International Adult Airway Symposium is coming up on February 4th & 5th. For more information view the itinerary or register here!

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

Associate Professor

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

Co-Director

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

Consultant Laryngologist

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.

Meet our Presenters for Day 2!

The International Adult Airway Symposium is coming up this weekend! For more information view the itinerary or register here!

Dr. Vyvy Young

Associate Professor and the Associate Residency Program Director in the Department of Otolaryngology-Head and Neck Surgery

University of California – San Francisco

VyVy Young, MD, is an Associate Professor and the Associate Residency Program Director in the Department of Otolaryngology-Head and Neck Surgery at the University of California – San Francisco. Dr. Young received her undergraduate and medical degrees from the University of Louisville, in Louisville, Kentucky, where she also pursued her Otolaryngology training. She then completed a fellowship in Laryngology and Care of the Professional Voice at the University of Pittsburgh Voice Center. She currently serves the American Academy of Otolaryngology – Head and Neck Surgery as member of the Annual Meeting Program Committee and Executive Committee for ENThealth.org. She is immediate past-chair of the Voice Committee and the Women in Otolaryngology Communications Committee and was recently selected as chair of the Finance and Audit Committee of the American Broncho-Esophagological Association.

Justin Roe, PhD, FRCSLT

Clinical Service Lead - Speech and Language Therapy – National Centre for Airway Reconstruction

Imperial College Healthcare NHS Trust

Dr. Roe is a clinical-academic and service lead, specialising in dysphagia in benign and malignant head and neck disease. He leads the speech and language therapy service for the National Centre for Airway Reconstruction at Imperial College Healthcare NHS Trust and is a consultant and service lead at the Royal Marsden NHS Foundation Trust. He is an Honorary Clinical Senior Lecturer at Imperial College London and an investigator on a number of NIHR portfolio studies. He is currently on an NIHR Imperial Biomedical Research Centre/ Imperial Health Charity funded post-doctoral research fellowship. He is an elected council member for the British Laryngological Association and British Association of Head and Neck Oncologists.

Professor Anil Patel MBBS PhD FRCA

Clinical Anaesthetist / Chairman of Department of Anaesthesia

Royal National ENT & Eastman Dental Hospital

Professor Anil Patel graduated from University College London in 1991. He is a clinical anaesthetist and continues to develop and refine the largest experience of anaesthetising adult airway patients under general anaesthesia (> 6,000 procedures) in the UK, probably Europe and possibly the world. His research interests include all aspects of shared airway and difficult airway management. Professor Patel has been an invited speaker to over 300 national and international meetings in 38 countries. He has over 130+ peer reviewed publications, 25 book chapters, over 4,500 citations and an h-index of 25.

Robbi A. Kupfer, MD

Associate Professor, Department of Otolaryngology-Head & Neck Surgery

University of Michigan

Dr. Kupfer is an Associate Professor of Otolaryngology-Head & Neck Surgery at the University of Michigan who specializes in Laryngology and Bronchoesophagology. She is the Program Director for the Laryngology Fellowship as well as the Otolaryngology Residency at the University of Michigan.

Alexander T. Hillel, MD, FACS

Associate Professor

Johns Hopkins University School of Medicine

Dr. Alexander Hillel is a Laryngologist, Residency Program Director, and Vice Director of Education in the Johns Hopkins Department of Otolaryngology – Head & Neck Surgery. His clinical practice and research centers on the treatment, prevention, and causes of laryngotracheal stenosis (LTS).

Dale Ekbom, MD

Associate Professor of Otolaryngology / Director of Voice Disorders/Laryngology

Mayo Clinic

Residency in Otolaryngology/Head and Neck Surgery at the University of Michigan with a fellowship in Laryngology/Care of the Professional Voice at Vanderbilt University Medical Center. Clinically specializing in voice, especially management of vocal fold paralysis, Zenker’s diverticulum and Cricopharyngeal muscle dysfunction, early laryngeal cancer, and airway compromise due to laryngeal, subglottic, and tracheal stenosis. Research interests include idiopathic subglottic stenosis and GPA with surgical and medical management of the airway, vocal fold paralysis, new injectables using Jellyfish collagen.

Dr. Ricky Thakrar

Consultant Chest Physician

University College London Hospital

Dr. Ricky Thakrar qualified in Medicine from Imperial College London. He trained in Respiratory Medicine at the Royal Brompton Hospital and completed his training in Northwest London. He was appointed to a three-year academic fellowship at UCL where his PhD examined state of the art bronchoscopy techniques for managing cancers arising in central airways and lung. He is a Consultant in Thoracic Medicine and his main interests are in interventional bronchoscopy procedures (laser resection, airway stenting, cryotherapy, photodynamic therapy and brachytherapy) for pre-malignant and malignant disease of the tracheobronchial tree.

Dr. Michael Rutter

Director of the Aerodigestive Center

Cincinnati Children's Hospital

Dr. Rutter is an ENT surgeon specializing in pediatric otolaryngology with an emphasis on airway problems in children, adolescents and young adults. His interests include tracheal reconstruction and complex airway surgery. Always a problem-solver, he strives to involve the patient in their own care by having them help evaluate the issue and then craft a solution together. He was drawn to his career by the challenge and highly individualized nature of pediatric airway problems and management. Dr. Rutter enjoys working in a multidisciplinary team setting and focusing on coordinated care for complex childhood airway conditions. He was honored to receive the 2016 Gabriel Frederick Tucker Award from the American Laryngological Association, and the 2018 Sylvan Stool Teaching Award from the Society for Ear Nose and Throat Advancement in Children (SENTAC). These awards are for his contributions to the field of pediatric laryngology. In addition to caring for patients, he is also dedicated to his research trying to find improvements in airway management.

Christopher T. Wootten, MD, MMHC

Director, Pediatric Otolaryngology—Head and Neck Surgery

Vanderbilt University Medical Center

Dr. Wootten has a longstanding interest in surgical management of congenital and acquired airway disorders.  To better equip himself to lead the Pediatric ENT service through expansion, evolution of practice models, and differentiation into multidisciplinary care, Dr. Wootten obtained a Masters of Management in Health Care at Vanderbilt’s Owen School of Business in 2017.  Areas of his professional research emphasis include airway obstruction in children and adults and aerodigestive care. He innovates minimally invasive surgical techniques in the head and neck.  Dr. Wootten is actively investigating the role of eosinophil and mast cell-based inflammation in the pediatric larynx.

Karla O'Dell, M.D.

Assistant Professor / Co-director

USC Voice Center, Caruso Department of Otolaryngology Head and Neck Surgery @ University of Southern California / USC Center for Airway Intervention and Reconstruction

Karla O’Dell, MD, specializes in head and neck surgery and disorders of the voice, airway and swallowing. She is cofounder and codirector of the USC Airway Intervention & Reconstruction Center (USC Air Center).

Jeanne L. Hatcher, MD, FACS

Co-Director of the Emory Voice Center and Associate Professor of Otolaryngology

Emory University School of Medicine

Dr. Hatcher has been at Emory since 2014 after completing her laryngology fellowship with Dr. Blake Simpson; she specializes in open and endoscopic airway surgery as well as voice disorders. Dr. Hatcher is a member of the ABEA and post-graduate member of the ALA and also serves on the Ethics and Voice Committees for the American Academy of Otolaryngology Head and Neck Surgery.

Mr. Lee Aspland

Patient / Freelance Artist

Lee Aspland Photography

Lee Aspland is a photographer, author and mindful practitioner who creates photography that reflects his feelings about living in such a glorious world. He specializes in Mindful Photography, capturing a fleeting feeling or thought, a hope or fear, a frozen single moment in time.

Gemma Clunie, MSc, BA (Hon), MRCSLT

Clinical Specialist Speech-Language Pathologist (Airways/ENT) and HEE/NIHR Clinical Doctoral Research Fellow

Imperial College Healthcare NHS Trust/ Imperial College London, Department of Surgery & Cancer

Gemma is a Clinical Specialist Speech and Language Therapist with an interest in voice and swallowing disorders that is particularly focused on the benign ENT, head and neck, respiratory and critical care populations. Gemma is a current NIHR/HEE Clinical Doctoral Research Fellow at Imperial College London. Her PhD studies focus on the voice and swallowing difficulties of airway stenosis patients. She is based at Charing Cross Hospital in London where she has worked for the last six years as part of the National Centre for Airway Reconstruction, Europe’s largest centre for the management of airway disorders.

Niall C. Anderson, CPsychol, MSc, BSc

Lead Psychologist (formerly Respiratory Highly Specialist Health Psychologist)

Bart's Health NHS Trust (formerly Central & North West London NHS Foundation Trust)

Niall is a HCPC Registered & BPS Chartered Practitioner Health Psychologist, and BPS RAPPS Registered Supervisor. Niall has specialist experience of working within healthcare systems with people with long-term health conditions at all system levels to support physical, psychological and social wellbeing. Niall worked in the Airway Service at Charing Cross Hospital (London, UK) between January-December 2021 in order to develop and implement the Airway Psychology Service.

Introducing a Two-Part Sialendoscopy Series!

Brought to you by our partnership with Cook Medical, we are having a two-part series on Sialendoscopy. The sessions will feed into one another, the first covering basics like a review of instrumentation and set up, as well as some of the most basic interventions you will see.

The second session will assume a basic knowledge of the procedure and will deal with complex interventions including both endoscopic and combined open procedures, advanced radiology, and complication management for revision surgery and in-office procedures.

Meet the Course Directors!

Rohan R. Walvekar, MD

Assistant Professor in Head Neck Surgery

University of Pittsburgh/VA Medical Center

Rohan R. Walvekar, MD, earned his doctoral degree from the University of Mumbai. After graduating in 1998, he completed a residency in Otolaryngology and Head Neck Surgery at the TN Medical College & BYL Nair Charitable Hospital, Mumbai, India, with triple honors. Subsequently, he completed two head neck surgery fellowships, and trained at at the Tata Memorial Hospital, Mumbai, which is India's most prestigious cancer institute. After completing an Advanced Head Neck Oncologic Surgery fellowship at the University of Pittsburgh, he became an Assistant Professor in Head Neck Surgery within the Department of Otolaryngology Head Neck Surgery at the University of Pittsburgh/VA Medical Center, prior to joining the LSU Health Sciences Center in July 2008. His clinical interests are head neck surgery and salivary endoscopy. His research interests include evaluating prognostic markers and clinical outcomes of head and neck cancer therapy and treatment of salivary gland disorders.

Barry M Schaitkin, MD

Professor of Otolaryngology

UPMC Pittsburgh

Dr. Schaitkin specializes in the treatment of inflammatory and neoplastic conditions of the salivary glands. He practices at UPMC in the Department of Otolaryngology and is affiliated with UPMC branches all across the city of Pittsburgh. He completed his medical degree and residency at Pennsylvania State University College of Medicine.

Meet the Presenters!

Jolie Chang, MD

Associate Professor, Chief of Sleep Surgery and General Otolaryngology

University of California, San Francisco

Dr. Chang specializes in sleep apnea surgery and minimally invasive approaches to the salivary duct with sialendoscopy. She has interest in studying patient reported outcomes after sialendoscopy procedures.

Mark Marzouk, MD

Clinical Associate Professor of Otolaryngology - Head and Neck Surgery

SUNY Upstate Medical University

Dr. Marzouk completed his residency training in 2010 from the UPMC Department of Otolaryngology. He is currently the Division Chief of Head and Neck Oncologic Surgery in Syracuse. He is also the Associate Program Director of Residency Programs.

David W. Eisele, MD. FACS

Andelot Professor and Director - Department of Otolaryngology-Head and Neck Surgery

Johns Hopkins University School of Medicine

Dr. Eisele is the Past-President of the American Board of Otolaryngology- Head and Neck Surgery and a member of the NCCN Head and Neck Cancer Panel. He has served as a member of the Residency Review Committee for Otolaryngology, as Chair of the Advisory Council for Otolaryngology - Head and Neck Surgery for the American College of Surgeons, President of the American Head and Neck Society, and as Vice-President of the Triological Society. He served as President of the Maryland Society of Otolaryngology and is a former Governor of the American College of Surgeons.

M. Boyd Gillespie, MD, MSc, FACS

Professor and Chair

UTHSC Otolaryngology-Head and Neck Surgery

M. Boyd Gillespie is Professor and Chair of Otolaryngology-Head & Neck Surgery at University of Tennessee Health Science Center. He is a graduate of the Johns Hopkins University School of Medicine where he a completed residency and fellowship in Otolaryngology-Head & Neck Surgery. Dr. Gillespie earned a Masters in Clinical Research at the Medical University of South Carolina, and is board certified in Otolaryngology-Head and Neck Surgery and Sleep Medicine. He has published over 150 academic papers and is editor of the textbook Gland-Preserving Salivary Surgery: A Problem-Based Approach. He is a former Director of the American Board of Otolaryngology-Head & Neck Surgery (ABOHNS) and current member of the otolaryngology section of the Accreditation Council for Graduate Medical Education (ACGME).

M. Allison Ogden, MD FACS

Professor & Vice-Chair of Clinical Operations - Department of Otolaryngology

Washington University School of Medicine

Dr. Ogden is a Professor and Vice-Chair of Clinical Operations in the Department of Otolaryngology at Washington University School of Medicine. She graduated from the Washington University School of Medicine in 2002 and went on to complete her residency there as well in Otolaryngology in 2007. Her clinical interests include sialendoscopy, nasal obstructions, and hearling loss. In 2015 Dr. Ogden was listed in "Best Doctors in America", an honor that continues to this day.

Arjun S. Joshi, MD

Professor of Surgery

The George Washington University School of Medicine & Health Sciences

Arjun Joshi, MD is board-certified in Otolaryngology and Head & Neck surgery by both the American Board of Otolaryngology – Head and Neck Surgery and the Royal College of Physicians and Surgeons of Canada. Dr. Joshi received his medical degree from the State University of New York at Syracuse and completed his residency at The George Washington University Medical Center. His areas of expertise include: Head and Neck Cancer, Head and Neck Masses, Head and Neck Reconstruction, Thyroid and Parathyroid Surgery, and Salivary Endoscopy.

Henry T. Hoffman, MD

Professor of Otolaryngology / Professor of Radiation Oncology

University of Iowa Healthcare

Dr. Henry T. Hoffman is an ENT-otolaryngologist in Iowa City, Iowa and is affiliated with University of Iowa Hospitals and Clinics. He received his medical degree from University of California San Diego School of Medicine and has been in practice for more than 20 years.

David M. Cognetti, MD, FACS

Professor and Chair of Department of Otolaryngology-Head & Neck Surgery

Thomas Jefferson University

Dr. Cognetti received his BS in Biology from Georgetown University and his MD from the University of Pittsburgh School of Medicine. He completed a residency in Otolaryngology – Head and Neck Surgery at Thomas Jefferson University before completing a fellowship in Advanced Head and Neck Oncologic Surgery at the University of Pittsburgh Medical Center. Dr. Cognetti returned to Jefferson, his professional home, as faculty in 2008.

Physician perspectives: Sialendoscopy during COVID-19

COVID-19 has changed the way that physicians are thinking about patient care, forcing them to adapt to new technologies and protocols. It has also given physicians the opportunity to think about the future of medicine, including what it may look like after COVID-19. Through this blog series, we’re interviewing physicians to share their first-hand experiences on how they’re adapting their practices during the COVID-19 pandemic, as well as their thoughts on the future of patient care.

We interviewed Rohan R. Walvekar, MD, to get his perspective on patient care and what the future of sialendoscopy procedures may look like during the COVID-19 pandemic. Dr. Walvekar is the Director of Salivary Endoscopy Service and the Co-Director of ENT Service University Medical Center in the department of Otolaryngology Head & Neck surgery at the Louisiana State University Health Sciences Center in New Orleans, Louisiana.

Below are some highlights of the interview. For the full interview, download the PDF here.

The future of sialendoscopy procedures

How have sialendoscopy procedures changed to adapt to COVID-19 in your practice?

COVID-19 has definitely changed our practice patterns, especially for outpatient services. Many of the otolaryngology procedures, including sialendoscopy, are now considered high-risk since they are aerosol-generating procedures (AGPs). Patients who need an interventional procedure, whether it is a routine flexible endoscopy as a normal part of a head and neck examination during their visit or an interventional sialendoscopy procedure, are now required to have a COVID-19 test within 48 to 72 hours of their in-office procedure, since these are all considered to be AGPs. Some of our clinic spaces have been re-structured to provide negative pressure ventilation in the rooms. In-office AGPs are performed in these negative pressure rooms with proper PPE precautions. Many practices at some sites, including ours, have moved to the use of disposable scopes and equipment when possible for COVID-19-positive patients. Social distancing and its impact on triaging patients, the need for COVID-19 testing, and the need to use additional sterilization procedures to clean and turnover clinic rooms, e.g., UV light technology, has significantly reduced overall patient volumes in clinics. Some of these factors have also impacted surgical turnovers in the hospital setting, impacting surgical volumes. However, these precautions have been vital to help keep our patients, staff, and other healthcare professionals safe during this pandemic.

How will the procedural landscape for salivary gland treatment change?

The thought process for salivary intervention will be influenced by the COVID-19 status. For COVID-19-negative patients, the procedural landscape may remain the same. However, if the patient is COVID-19 positive, then the surgical intervention will be postponed until the patient is past the infective phase, i.e., after 14 days of quarantine and after demonstrating two successive COVID-19-negative tests. Or, if intervention is necessary, a gland excision route may be preferred for certain indications where intra-oral intervention may be complex and have a high risk of viral shedding—for example, an intermediate sized (5-6 mm) hilar stone in the submandibular gland that needs a combined approach procedure, laser fragmentation of hilar-intraglandular stones, or possibly an endoscopic management of high-grade diffuse stenosis. All of these conditions are surgical challenges.

It is more likely that procedures will move from in office to the operating room setting as the intervention is more controlled and measured. All healthcare professionals can take adequate PPE precautions, and once the patient is intubated, the risk of viral shedding decreases compared to an awake patient, who may cough, sneeze, or have a robust gag reflex.

Innovations will come in various ways to help the current situation. Innovations such as the ACE2-X solution could be helpful, if proven effective, to help reduce viral burden and make intervention safer. There are many new innovations, such as innovative techniques to perform examinations, negative pressure environments, and perforated face masks or helmets to allow ENT examinations.

Sialendoscopy products

Do you anticipate an increase in demand in Cook’s minimally invasive sialendoscopy products?

I do anticipate an increase in the demand for certain Cook products, especially the disposable access catheters and wire guides. There also may be an increase demand for the use of the SialoCath^® Salivary Duct Catheter, which may be considered for irrigation and washout procedures for chronic sialadenitis, radioactive iodine induced sialadenitis, and Sjogren’s syndrome. Dilation followed by only irrigation with saline, or antibiotics or steroids, or a combination thereof may be a less-invasive alternative to endoscopy and pose a reduced risk of contamination to the salivary endoscope. For centers equipped with negative pressure clinics, the ability to perform these procedures may help reduce the demand for operating room time, which is already reduced due to the requirement for resource management and PPE conservation.

In the full interview, Dr. Walvekar also answers the following questions:

The future of sialendoscopy procedures

• As otolaryngology procedures start back up, how quickly do you see sialendoscopy procedures returning?
• How have patient consultations and physical examinations changed?
• How have you implemented PPE into your practice?
• How are the examination rooms set up?
• How are you screening patients for COVID-19?
• We have heard of some physicians changing from betadine to chlorhexidine for prep prior to salivary and sialendoscopy procedures. Do you have any thoughts on this and the impact on COVID-19?
• How do you see hands-on educational courses adapting to further physician education?
• Will there be a shift away from surgical procedures?

Sialendoscopy products

• Do you anticipate an increased usage of the Advance^® Salivary Duct Balloon Catheter by bringing more stricture patients into the office and using ultrasound?
• Do you anticipate an increase in the preference of disposable sialendoscopy devices over reusable devices?

To learn more about Cook’s products for sialendoscopy, click here.

Dr. Walvekar is a paid consultant of Cook Medical.
The opinions expressed by Dr. Walvekar in this interview are his own, and not the opinions of Cook Medical, and represent his experience within his practice.

Source: Cook Medical

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